The lunate bone is in the top row of bones in the wrist. It is located between the trihedral and navicular connective tissue. This bone is subjected to a fairly strong mechanical stress. That is why she often suffers from necrosis. Fractures and dislocations of this bone are rare.
Causes of fractures
As a rule, the cause of a fracture of such a bone is indirect trauma. Rarely is it straight. Fractures are of several types. There are longitudinal, fragmentation, transverse, tear-off.
Fracture symptoms
Fracture of the lunate resembles problems with the wrist joint. The first thing that should alert you is problems with wrist movement. When trying to deflect the hand, the patient will feel severe pain. On palpation, it intensifies and radiates to other bones.
It is impossible to bend the arm into a fist because the pain symptom reappears. To confirm the diagnosis, an x-ray must be taken.
Fracture treatment
Fracture is usually treated conservatively. In this case, it is necessary to put a plaster on the arm. Term: up to 2 months. After removing the bandage, it will be necessary to develop movements in the joint of the hand and the wrist joint. The doctor will prescribe physiotherapy exercises and UHF.
In the event that a fracture of the lunate bone is accompanied by nonunion or fragments, then you need to contact a surgeon. He will perform arthrodesis, arthroplasty or arthroplasty. What procedure will be carried out depends entirely on the severity of the problem.
Dislocations
Often, a fracture is accompanied by a dislocation. In men 20-40 years old, a perilunar type of problem occurs. At risk are those who are engaged in heavy physical labor.
The peculiarity of the dislocation of the lunate bone is that most often the bones around it are in the wrong position, and she alone is in the correct position. The above described perilunar problem is often accompanied by a fracture of the navicular bone. The treatment will be quite difficult and long.
How does a dislocation occur? As a rule, it occurs with indirect exposure. For example, when a person falls on the palm, the bones are strongly bent, and then shifted to the dorsal side. Due to the fact that the lunate bone is quite firmly connected to the radius, it remains in place or shifts towards the radiocarpal ligament.
Dislocation symptoms
Of the characteristic external symptoms, it should be noted that the wrist of the victim thickens, the fingers are inbent state. There may be a strong pain effect due to the fact that the nerves are strongly compressed.
In order to make a diagnosis, it is important to take the correct history. In addition, a lateral view x-ray is needed.
Dislocation treatment
To put the hand and the lunate bone in order, you need to reposition. The capitate should be pulled a long distance. Due to this, the described bone is reduced by pressure. This method only takes place if the injury occurred a few hours ago. In the event that several days have already passed, then the reposition will not be so effective.
If the patient went to the doctor only after a few weeks, then this method is pointless to use. In this case, an operation is performed that allows the bone to be surgically inserted into place. If the injury occurred more than 12 weeks ago, then more complex methods are used.
In the event that the dislocation could not be corrected, the patient will have a picture of an old problem. This leads to the fact that the wrist swells, moving the fingers and hand is quite painful. In this case, only surgery will help.
Bone necrosis
At the moment, five stages of necrosis of the lunate bone are known. Unfortunately, not in all cases it is possible to clearly distinguish between them.
- In the first stage, the bone substance begins to disintegrate. However, the cartilage remains normal. At this stage, the semilunar connective tissue already becomes almost non-functional. If a strong physical impact is exerted on it, a fracture will occur.
- The second phase is characterized by the fact that a fracture of the compression form occurs. Dense bone mass begins to form.
- At the third stage, the compressed bone begins to dissolve. At the same time, cartilage becomes less functional, as their integrity is violated.
- The fourth phase is characterized by the fact that the tissue subject to necrosis is resorbed. New bone tissue arises, while the bones and cartilage turn into a spongy formation. Cysts may appear. The shape of the semilunar bone of the wrist changes, and all the processes that occurred during this stage and earlier are already considered irreversible.
- The last - fifth - stage is characterized by the fact that osteoarthritis of the wrist joint is formed. It is impossible to stop its formation.
It is important to see a doctor at least at the first or second stage in order to be able to stop necrosis with minimal consequences.
Symptoms of necrosis
Most often, necrosis of the lunate bone develops quite quickly. At the same time, symptoms and functional problems are noticeable almost immediately. However, there are those people in whom the problem develops slowly. To make a diagnosis and confirm it, it is important to take an x-ray.
This problem is typical for people who do physical work. Most often, installers and stampers turn to the doctor. Their symptoms are divided into permanent and temporary. 60% of all patients have swelling at the site of the described bone. A similar manifestation can also occur in patients in whom the problem arose both a few months ago and more than 3-4 years ago. Palpation causes severe pain.
Treatment of necrosis
Conservative and surgical treatment can be used to bring the lunate back to normal. The first type of therapy is often effective only in eliminating symptoms and reducing pain. Many doctors perform immobilization of the wrist joint. However, even with the fact that this method is effective, its results are reduced to zero when you return to work. Therefore, it is important to contact the surgeon in time. Although, even the operation does not always lead to the desired result.
The whole problem is not even that surgical intervention requires a lot of experience and certain skills. Often, due to the operation, the patient develops osteoarthritis, and the function of the wrist joint is still reduced to zero. In the early stages of a problem, surgery may be successful.
Recovery after surgery
If the patient had necrosis, which is also called osteochondropathy of the lunate bone, then after the operation it is important to follow certain rules. They will help restore the work of the brush:
- It is necessary to go to therapeutic gymnastics, perform physiotherapy procedures with the help of a phonoresis, ultrasound.
- In some cases, the doctor advises to rest in a sanatorium.
- Drugs that relieve pain and improve blood circulation will be prescribed without fail.
Results
The lunate bone has a special location, so it is difficult to injure it. However, if this did happen, it will be quite difficult to recover. Necrosis is considered the most severe pathology. It is impossible to get rid of it in most cases. It is possible to help the patient only at the earliest stage. However, the likelihood of a complete cure is still minimal.
