Classification

Like many things in medicine, lunatum malaria is divided into different stages, and as the disease progresses the stage increases. The most common is the division according to Decoulx into four stages. In stage 1, changes in bone density can only be detected by MRI. In stage 2, the first damage to the bone becomes apparent, some of which can already be detected on X-ray. In stage 3, the bone is already beginning to “crumble” and in stage 4 the lunar bone is completely destroyed, the wrist is also affected and in some cases adjacent bones are also damaged.

Therapy

If you suffer from lunatum malacia, it is important to know what treatment options are available. Depending on the stage of the disease, other procedures are available. At a very early stage, surgery may be avoided, but the likelihood of this is rather low.In stages 1 and 2, you can try to immobilize the wrist for a relatively long time and thus relieve the strain on it.

For this purpose, either a plaster splint or a bandage is worn for three months. After that, a check is made to see whether the blood circulation of the lunate bone has improved. If this is the case, surgery can be avoided under certain circumstances.

Usually, however, surgery is necessary, although the type of surgery differs depending on the initial situation. If the ulna, i.e. a forearm bone, is shortened, this puts considerable strain on the lunar bone, as already mentioned. Therefore, in this case the other bone of the forearm, the radius, is also shortened by a few millimeters in one operation, in order to relieve the load from the moon bone.

However, if ulna and radius are already the same length and a lunatum malacia still develops, it is possible to remove the damaged moon bone and replace it with the normally not so important pea bone (another carpal bone). This operation is called Saffar surgery. If, in the course of the disease, neighboring bones have also shifted, quite often the carpal bones have to be partially united to prevent a malposition.

In the worst case, when considerable parts of the wrist are already affected and the lunar bone is already in considerable disintegration, the last resort is to surgically stiffen the wrist to prevent the pain. As the name suggests, however, the wrist is stiff afterwards. However, the fingers can still be moved freely, allowing the hand to be used to a large extent.

The rotation of the hand is not affected either, since it does not take place in the wrist. A replacement by an artificial material was tried in the past, but no material could replace the bone sufficiently. In most cases the implants shifted or broke under load, which is why nowadays no implants are used for the lunar bone.