Safe-Zones for Surgical Intervention in the Lunate: a Micro-CT Study

The intraosseous vascular system of the lunate has been extensively studied and described by others (1,2). A novel technique was used in this study to assess the blood supply with Microfil injection and analysis with micro-CT. (3) In a current unpublished study, safe-zones for surgical interventions in the lunate bone are identified, which will help minimizing iatrogenic avascular necrosis of the lunate bone by respecting the intraosseous blood supply of the lunate bone, and changing our surgical approach accordingly. In this study 21.4% of the lunates relied on nutrient vessels entering exclusively from volar or dorsal. Surgical intervention using a volar approach is advised ulnar of the proximal-distal midline to prevent risk of vascular damage. A dorsal surgical approach is advised radial from the proximal-distal midline directed slightly to proximal (Figure 4). These quadrants have the least amount of vessels and are only supplying a small portion of the lunate. These findings will help minimizing iatrogenic avascular necrosis of the lunate bone by respecting the osseous blood supply of the lunate bone, and changing our surgical approach accordingly.