BACKGROUND: There are several surgical options for osteonecrosis of the lunate, and confirming the effectiveness of various surgical methods remains challenging. Here, we present a case of stage IIIB osteonecrosis of the lunate repaired with a free medial femoral condyle osteocutaneous flap.
METHODS: A 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient\'s medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points.
CONCLUSIONS: The success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.

This study aims to measure anatomical data of the capitate bone, develop an external fixator for treating late-stage osteonecrosis of lunate through Ilizarov technique, and evaluate its biomechanical performance. We selected eight wrist joint specimens to measure various parameters of the capitate bone, including its length, the distance from the junction of capitate head and body to the proximal end, as well as the width of its proximal head and distal body. Additionally, we measured these same indicators in 107 patients who had undergone wrist X-ray examination. Based on our measurements, we categorized the capitate bone into two groups and designed two types of capitate bone Ilizarov external fixator (CIEF) for it. Then, we compared it with the orthofix external fixator (OEF) through dynamic fatigue biomechanical experiments and pull-out resistance experiments. The results of the measurement revealed two categories of general patterns in the capitate bone. The first type maintains a consistent longitudinal axis between the proximal and distal ends. The second type is characterized by its proximal end being close to the radial side and its distal end being close to the ulnar side. In the dynamic tensile fatigue test, CIEF-A and CIEF-B had smaller maximum displacement values compared to the OEF (P < 0.05). In the anti-pull-out experiment, both CIEF-A and CIEF-B exhibited higher maximum pull-out force than the OEF (P < 0.05). CIFE is a treatment for advanced osteonecrosis of the lunate bone. It is specifically designed to align with the anatomical characteristics of the capitate bone, providing excellent biomechanical properties and a simple clinical procedure. However, additional clinical experiments are needed to confirm its effectiveness in the future.

OBJECTIVE: To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius.
METHODS: From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation.
RESULTS: All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good.
CONCLUSIONS: Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.

BACKGROUND: Incidence of lunate fractures is very low, less than 1% of all fractures. Lunate fractures generally come from high-energy injuries, often combined with other wrist fractures. Simple lunate fractures can be fixed with screws or Kirschner wires. However, Comminuted lunate fractures are difficult to reduce and fixe by conventional methods.
METHODS: Here we report a 42-year-old male construction worker who was crushed by an excavator bucket and presented with comminuted lunate fracture combined with distal radius fracture and scaphoid fracture.
METHODS: Comminuted lunate fracture, distal radius fracture, and scaphoid fracture.
METHODS: The posterior approach was used to reconstruct the radial lunate bone with polymethylmethacrylate cement, and cannulated screws were used to fix the scaphoid and distal radius fractures.
RESULTS: At the 3rd month after surgery, the movement of the right wrist joint improved. At the sixth month after surgery, the patient returned to the building site and began working at the same intensity as before the injury.
CONCLUSIONS: Although the incidence of comminuted lunate fractures is very low, they occur sometimes. For comminuted lunate fractures, early identification and intervention can preserve most of the function of the wrist joint.

UNASSIGNED: To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.
UNASSIGNED: One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.
UNASSIGNED: The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.
UNASSIGNED: The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.
UNASSIGNED: 设计定制化钛合金人工月骨假体，利用有限元分析构建假体置换前后腕关节三维有限元模型，观察置换术后腕关节生物力学改变，为假体临床应用提供生物力学依据。.
UNASSIGNED: 取1具新鲜冰冻人前臂标本，经cortex动作捕捉系统测量腕关节掌屈、背伸、尺偏、桡偏最大活动度分别为48.42°、38.04°、35.68°、26.41°。CT扫描获取腕关节数据，首先导入Mimics21.0软件、Magics21.0 软件初步构建腕关节三维模型，设计定制化钛合金人工月骨假体。然后采用Geomagic Studio 2017软件、Solidworks 2017软件构建正常腕关节、月骨假体置换术后腕关节三维有限元模型（正常模型、置换模型）。ANSYS 17.0有限元分析软件中，于腕关节掌屈15°、30°、48.42°，背伸15°、30°、38.04°，尺偏10°、20°、35.68°，桡偏5°、15°、26.41° 分析置换前后腕关节应力分布及形变，以及月骨及月骨假体的应力分布情况。.
UNASSIGNED: 研究成功构建假体置换前后腕关节三维有限元模型。掌屈、背伸、尺偏、桡偏方向不同活动度腕关节模型的网格划分节点及网格数存在一定差异。在掌屈、背伸、尺偏、桡偏方向，正常模型及置换模型腕关节最大形变均发生于桡侧，且均随活动度增大而逐渐增大；腕关节最大应力亦随活动度增大而逐渐增大，在最大活动度下应力均集中于桡骨近端，整体表现为由桡侧腕骨向桡骨近端移动的趋势。在不同方向上正常月骨最大应力均表现为随活动度增大而逐渐增大趋势，且应力位置发生对应改变。而月骨假体最大应力均集中在假体尺侧，背伸时随活动度增大逐渐增大，掌屈、尺偏、桡偏时则整体表现为随活动度增大而逐渐减小。术后月骨假体所受应力较正常月骨明显增大。.
UNASSIGNED: 有限元分析提示采用定制化钛合金人工月骨假体置换不会改变腕关节载荷传递模式，为假体临床应用提供数据支持。.

OBJECTIVE: Perilunate injuries are rare but devastating carpal injuries. The treatment of perilunate injuries remains challenging and contentious. This study aims to describe a novel mini-invasive surgical technique of arthroscopic-assisted reduction and robot-assisted fixation for the treatment of trans-scaphoid perilunate fracture dislocations (PLFDs).
METHODS: We retrospectively reviewed patients with PLFDs after surgical treatment from February 2021 to March 2021. The patients underwent arthroscopic-assisted precise reduction and robot-assisted headless screw fixation. Times of guide wire placement were recorded intraoperatively. Periodic follow-up was performed until union of scaphoid fracture was confirmed. Range of motion of the wrist, grip strength, the Visual Analog Scale (VAS) score, the Mayo Wrist Score, the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE), and osteoarthritis were evaluated at the final follow-up.
RESULTS: Two male patients presenting with PLFDs with an average age of 24.5 years old (32 and 17 years) were included in this study. Intraoperatively, anatomic reduction of the scaphoid fracture was achieved under arthroscopic guidance. A robotic-assisted single-attempt guidewire insertion was performed for scaphoid fracture and lunotriquetral interval. The CT scans at 8 and 12 weeks showed the union of the scaphoid fracture. At final mean follow-up of 13.5 months, the extension, radial-ulnar deviation, and pronation-supination were consistent with the contralateral side in both patients. One patient experienced mild limited range of motion with the flexion 46° of the injured wrist compared with 81°of the contralateral wrist. The VAS score was 0 and 2. The grip strength was 32 and 26 kg compared with 24 and 42 kg of the contralateral wrist. The PRWE score was 13 and 10 and the QuickDASH score was 2 and 7. The Mayo Wrist Score was 100 and 65. No sign of osteoarthritis was found at the last follow-up.
CONCLUSIONS: Arthroscopic-assisted reduction and robot-assisted fixation is a viable and promising alternative for the treatment of perilunate fracture dislocations. This technique allows precise reduction and accurate placement of the K-wires/screws into the carpal bones through the optimal biomechanical paths.

UNASSIGNED: To compare the parameters of screw implantation in capitolunate arthrodesis between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach based on CT images of the normal wrist, and provide reference for the selection of surgical approaches and planning of screw insertion trajectory.
UNASSIGNED: CT data of 50 patients who met the criteria between February 2022 and April 2022 were selected as the study objects. There were 30 males and 20 females, and the age ranged from 18 to 69 years (mean, 37 years). The normal wrist alignment was conformed in all CT images. All CT data from the unilateral wrist of the patients was imported into Mimics Medical 20.0 software to construct a three-dimensional plane model, in which a virtual 3.5 mm screw was implanted between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach. The angle between screw and coronal, sagittal, and transverse planes, the total length of the screw, the length of the screw in the lunate bone and the capitate bone were measured. The ratios of the length of the screw in capitate bone to the length of the long axis of the capitate bone, the length of the screw in lunate bone to the length of the long axis of the lunate bone, and the length of screw in lunate bone to the length of the screw in capitate bone were calculated. Assuming that the result of screw implantation between the 2nd and 3rd metacarpal bones was better than that via the distal dorsal capitate bone approach, the difference in length of the screw in the lunate bone between the two approaches was calculated, and the superiority test was performed.
UNASSIGNED: Compared with the distal dorsal capitate bone approach, the total length of the screw increased, the length of the screw in the capitate bone decreased, and the length of the screw in the lunate bone increased, the angle between the screw and coronal plane decreased, the angles between screw and sagittal, transverse planes increased after the screw was implanted between the 2nd and 3rd metacarpal bones. And the ratio of the length of the screw in capitate bone to the length of the long axis of capitate bone decreased, the ratio of the length of the screw in lunate bone to the length of the long axis of lunate bone increased, and the ratio of the length of the screw in lunate bone to the length of the screw in capitate bone also increased. All the differences were significant ( P<0.05). The difference in the length of the screw in the lunate bone between the two approaches was 1.86 mm [95% CI (1.54, 2.18) mm], which was greater than the superiority margin (1.35 mm). The superiority hypothesis was supported.
UNASSIGNED: Compared with the distal dorsal capitate bone approach, the screws implanted between the the 2nd and 3rd metacarpal bones in the capitolunate arthrodesis are longer in lunate bone and more vertical to the articular surface of the capitolunate joint. Theoretically, the capitolunate joint are more firmly fixed.
UNASSIGNED: 基于正常腕关节CT图像，分析头月关节融合术中经第2、3掌骨间及头状骨远端背侧缘入路植入螺钉的参数差异，为临床手术入路选择以及螺钉植入路径规划提供参考。.
UNASSIGNED: 选择2022年2月—4月符合标准的50例患者作为研究对象。男30例，女20例；年龄18～69岁，平均37岁。腕关节力线均正常。将患者单侧腕关节CT数据导入Mimics Medical 20.0软件，构建三维平面模型，分别模拟经第2、3掌骨间及经头状骨远端背侧缘入路植入直径3.5 mm螺钉。测量螺钉与冠状面、矢状面、横断面夹角角度，螺钉位于头状骨、月骨内长度以及螺钉总长度，计算相关指标比值（头状骨内螺钉长度/头状骨长轴长度、月骨内螺钉长度/月骨长轴长度、月骨内螺钉长度/头状骨内螺钉长度）。并假设经第2、3掌骨间入路植入螺钉效果优于经头状骨远端背侧缘入路，计算两种方式月骨内螺钉长度差值，行优效性检验。.
UNASSIGNED: 与经头状骨远端背侧缘入路相比，经第2、3掌骨间入路植入螺钉后，螺钉在头状骨内长度减小、在月骨内长度增加，螺钉总长度亦增加；螺钉与冠状面夹角变小，与矢状面、横断面夹角增大；头状骨内螺钉长度/头状骨长轴长度减小，月骨内螺钉长度/月骨长轴长度、月骨内螺钉长度/头状骨内螺钉长度增加；组间差异均有统计学意义（ P<0.05）。两种方式植入的螺钉在月骨内长度差值为1.86 mm ［95% CI（1.54，2.18）mm］，均大于优效界值（1.35 mm），优效性假设成立。.
UNASSIGNED: 与经头状骨远端背侧缘入路相比，头月关节融合术中经第2、3掌骨间入路植入的螺钉在月骨内更长、与头月关节面更垂直，理论上头月关节固定更牢固。.

暂无摘要。

UNASSIGNED: Previous literatures suggest that the prognosis of Kienböck\'s disease might be favorable despite no surgery if it is diagnosed in late age, but the evidence is not clear. The aim of this study was to determine the radiographic and clinical progression of Kienböck\'s disease diagnosed at more than 50 years of age.
UNASSIGNED: Data of 27 patients diagnosed with Kienböck\'s disease at more than 50 years of age between 2000 and 2016 were investigated. During the study period, no treatment, either surgical or nonsurgical, was applied. We explained to the patients that the affected lunate was not expected to collapse further if found late in age. Annual visits were recommended, through which radiographic and clinical observation was made. We assessed changes in Stahl index and radioscaphoid angle between the initial assessment and the final follow-up, and clinical assessment was made using pain in visual analog scale (VAS) and Dornan\'s criteria.
UNASSIGNED: Initially, 2 patients were in Lichtman stage 1, 6 in stage 2, 5 in stage 3A, 11 in stage 3B, and 3 in stage 4. Radiographic follow-up of at least 5 years (mean, 7.8 years) was made in 14 patients, whose Stahl index and radioscaphoid angle did not differ significantly from their initial measurements. Arthritic appearance was not found, and progression in the Lichtman stage was detected in 1 lunate, from 3A to 3B. Despite no surgical treatment for an average of 7.5 years (range, 5.0-15.7 years) of observation period in the 27 patients, average pain in VAS improved from 3.5 (range, 1-7) to 0.8 (range, 0-2), with excellent or good clinical status by Dornan\'s criteria.
UNASSIGNED: Our study suggests that Kienböck\'s disease diagnosed at more than 50 years of age can follow a benign natural course in radiographic and clinical aspects. Therefore, surgical interventions should be considered carefully in this age group.

OBJECTIVE: The paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.
METHODS: Anteroposterial-lateral radiographs of the patient\'s wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.
RESULTS: Twenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg\'s perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00-21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75-2.00) and 100.00 (interquartile range, 100.00-100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.
CONCLUSIONS: It is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.