Lunatomalacia or avascular necrosis of the lunate in children is a rare disease not described by Kienböck. It is somewhat surprising that the term Kienböck's disease has been used to describe this disease of the lunate in children. We report our experience in 13 cases and review the literature. In children under 12, the prognosis is very good after immobilization alone. Persistent symptoms may indicate surgery, probably radial shortening, in some older teenagers although the outcome appears better than in adults. We suggest the term lunatomalacia to describe this disorder, in recognition of the term originally used by Kienböck.
A definite pathogenesis for Kienböck's disease (KD) has not been identifed yet. Considering our clinical experience, mechanical factors, acute trauma or repetitive minor trauma seem to not be a primary cause, but rather factors that cause symptom aggravation of an already present KD. I feel we should look for a biological more than for a mechanical cause. Probably a vascular non-traumatic process, with a minor infarction pattern in the proximal subchondral area, is nearest to the truth. Bone remodelling results from bone resorption by osteoclasts and the formation of new bone by osteoblasts. Why osteoclast action should overpass the osteoblastic activity in the repair process is still not known. Studies of genes related to osteogenesis with polymerase chain reaction (PCR) arrays are a new option. Considering avascular necrosis as a possible reactive arthritis, PCR and viral RNA analysis could help in making the diagnosis.
Las polidactilias del pulgar, especialmente sus duplicaciones, constituyen una anomalía de frecuente presentación. Sus variantes son múltiples, lo que nos obliga a conocer cuáles son las diferencias anatómicas más relevantes en cada tipo en particular. Han sido muchas sus clasificaciones, pero la propuesta por Wassel, basada en los hallazgos radiológicos, continúa siendo tan simple como práctica. Excepto en los casos más simples, su cirugía reconstructiva es difícil, y debe ser encomendada a cirujanos con experiencia. Aun así, en los casos complejos el resultado dista de ser la obtención de un pulgar «normal», incluso con la técnica de «resección y reconstrucción» que utilizamos y que describimos en el presente artículo. Con frecuencia el tratamiento de las polidactilias se considera como algo simple y banal, y su dificultad real solamente se hace patente con el resultado desastroso de la cirugía. Las complicaciones que pueden presentarse son diversas y, en un significativo número de casos, van a requerir posteriormente una nueva cirugía reconstructiva para mejorar el resultado funcional y/o estético.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.