Pediatric and Adolescent Kienböck’s Disease

ABSTRACT

The etiology of Kienböck’s disease is controversial and not yet universally agreed upon. Similarly, no agreed upon method of treatment for Kienböck’s disease exists.

An association between lunate vascularity, ulnar variance (the relationship between the distal radius and distal ulna length), and disease development has been noted. The association between ulnar variance and Kienböck’s disease is the basis of the currently popular treatment options joint leveling, lunate revascularization, partial intercarpal arthrodesis, and carpal excisions. Clinical studies have shown that, when performed according to accepted indications and disease stage, each procedure shares similar success. Unfortunately, these studies are based almost entirely on data drawn from adult patient populations. To date it remains unclear whether pediatric and adolescent Kienböck’s disease stems from a particular etiology, and whether this patient population will respond similarly to the adult population.

Kienböck’s disease in young people is rare. The reported incidence is <1.5% for patients aged <16 years. Several case reports have supported immobilization as the preferred treatment for Kienböck’s disease in young people. With the exception of a small number of studies, this conservative treatment method has not been successful in the adult patient population. It is now common to treat Kienböck’s disease surgically in adults.

This study addressed whether the young patient with Kienböck’s disease would respond more favorably to nonoperative care, immobilization, than the adult population. Due to its rarity, our series of eight pediatric and adolescent patients with Kienböck’s disease is the largest compiled group to date.