This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by LEDOUX, P. Articles by SCHUIND, F. Search for Related Content PubMed Articles by LEDOUX, P. Articles by SCHUIND, F. Social Bookmarking                         What's this?

A Finite-Element Analysis of Kienböck’s Disease

From the Faculté Polytechnique Mons, Mons, SOS Main, Clinique du Parc Léopold, Brussels, and the Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium

Correspondence: Frédéric Schuind, MD, PhD, Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium. Tel.: +32 2 555 36 45; fax: +32 2 555 83 60. E-mail: frederic.schuind{at}erasme.ulb.ac.be.

A finite-element analysis model of the lunate was established using geometrical data obtained from cadaveric bones. The lunate cortex was modelled with triangular and quadrilateral elements and its intraosseous structure was represented either as a homogenous elastic structure or as an anisotropic network of cortical bone beams (trabeculae) with different orientations and thicknesses. Compressive loads applied to the metacarpus were distributed in the carpus against the fixed radius and ulna. The ulnar variance had a strong influence on the ratios radiolunate/ulnolunate total load and peak pressures. The distribution of internal stresses was markedly affected by the lunate uncovering index. The evolution of a simulated incomplete fracture was dramatically influenced by morphological parameters: with positive ulnar variance, the fracture did not progress, but in the presence of three associated conditions, negative ulnar variance, a high lunate uncovering index and angulated trabeculae, the fracture progressed and the proximal part of the lunate collapsed. This study supports the concept that some lunates are predisposed to Kienböck’s disease because their anatomy induces abnormal internal stresses, which allow an incomplete fracture to progress, under heavy loading conditions, and cause progressive collapse and localised trabecular osteonecrosis.

Key Words: Kienböck’s disease • osteonecrosis • finite-element analysis • wrist • ulnar variance • lunate uncovering index

Journal of Hand Surgery (European Volume), Vol. 33, No. 3, 286-291 (2008)
DOI: 10.1177/1753193408090757


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?