[Results of treatment of semilunar bone necrosis. A study of 91 patients].

The results of nine different methods for treating patients with lunate necrosis were investigated in a retrospective study. The study included seventy-eight of eighty-two operated patients with an average follow-up of five years and thirteen of thirty-five patients conservatively treated were examined at an average follow-up time of nine years. Treatments used were: shortening of the radius, lengthening of the ulna, pisiform transposition, prosthetic replacement, tendon interposition arthroplasty, STT-arthrodesis (scaphotrapezio-trapezoid arthrodesis), denervation of the wrist, wrist arthrodesis, and conservative therapy. The most important criteria for rating the results were pain relief, range of motion, grip strength, and X-ray findings. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius. In intermediate stages good results could be achieved by tendon interposition arthroplasty. Denervation and STT-arthrodesis can be performed at any stage of the disease and may be combined with other methods. Despite some good results, a search for even better operative methods should continue, because the available techniques, especially in cases of advanced necrosis, do not always lead to satisfactory results.