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Stage 1
- The lunate appears normal on xray or there may be a nondisplaced fracture; MRI demonstrates loss of signal consistent with osteonecrosis.
- Treatment: spinting, activity modifications, NSAIDs
- Consider ulnar lengthening or radial shortening for patients with negative ulnar variane.
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Stage 2
- Increased lunate radiodensity without loss of contour; lunate not collapsed.
- Treatment: 4 + 5 extensor compartmental vascularized bone graft. (Moran CL, J Hand Surg 2005;30A:50).
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Stage 3A
- Increased lunate radiodensity and fragmentation without loss of carpal height.
- Treatment: 4 + 5 extensor compartmental vascularized bone graft. (Moran CL, J Hand Surg 2005;30A:50).
- Consider scaphocapitate arthrodesis, or scaphotrapeziotrapezoid arthrodesis
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Stage 3B
- Lunate fragmentation with proximal migration of the capitate and rotation of the scaphoid.
- Treatment: scaphocapitate arthrodesis, or scaphotrapeziotrapezoid arthrodesis
- Consider Proximal Row Carpectomy
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Stage 4
- Lunate severely collapsed and fragmented, secondary arthritic changes in the wrist.
- Treatment: Proximal Row Carpectomy.
- Consider: scaphocapitate arthrodesis, and scaphotrapeziotrapezoid arthrodesis.
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