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Images in clinical medicine

A case of lunatomalacia

A case of lunatomalacia

Parth Shah1,&


1Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India



&Corresponding author
Parth Shah, Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India



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Lunatomalacia is a condition characterized by avascular necrosis of the lunate bone. It is also known as osteonecrosis, Kienbock's disease, and aseptic or ischemic necrosis of the lunate. Although the mechanisms by which this disorder develops are not fully understood, compromise of the bone vasculature is the most commonly proposed cause. Both extraosseous and intraosseous blood vessels supply the lunate bone. Vessels that enter the lunate through the dorsal and volar poles of the bone make up the extraosseous blood supply. Pathomechanics where acute trauma or repetitive minor trauma leads to direct vessel break and ligament disruption causes blood supply interruption and bone necrosis. A 31-year-old male presented to the orthopedics outpatient department with pain and swelling over the right wrist since 1 year. Patient gave alleged history of trauma to wrist while lifting heavy object and Pain was sudden in onset, gradually progressive in nature and dull aching type which got aggravated by lifting weights and got relieved by taking rest and medication. On local examination, tenderness presented over radial styloid, ulna styloid and medial radio-ulnar joint. Wrist range of motion (ROM) range normal and terminally painful. Fovea sign - positive, suggest triangular fibrocartilage complex injury. Pain on ulnar deviation of wrist. The patient was managed with a form of splinting.

Figure 1: (A) X-ray of right wrist shows sclerosis of lunate and negative ulnar variance; (B) coronal T1-weighted mitral regurgitation (MR) image showed diffuse hypo intensity of lunate bone; (C) MR image showed coronal fracture of lunate bone