Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures

Abstract

Objective To evaluate the outcomes and complication rate of surgical management in adolescent patients with Kienböck's disease and compare lunate offloading and revascularization procedures.

Methods We performed a retrospective chart review to evaluate adolescent patients with Kienböck's disease between 1990 and 2016 who were surgically managed. Charts were reviewed for demographic information, presence of trauma, range of motion, grip strength, and radiographic parameters pre- and postoperative.

Results We assessed 21 wrists in 20 patients. All had failed conservative management and required surgery. Seven patients underwent lunate offloading procedures, most commonly radial-shortening osteotomy, whereas 13 patients had an attempt at revascularization. All patients had either minimal or no pain at a clinical mean clinical follow-up of 63.4 months. Postoperatively, grip strength and radial deviation improved, with no difference between the two groups. Those that underwent joint offloading procedures had less ulnar variance. Eight of 11 patients with a postoperative MRI (magnetic resonance imaging) had evidence of lunate revascularization after a revascularization procedure.

Conclusion Surgical management of Kienböck's disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management.

Level of Evidence/Type of study This is a Level IV, therapeutic study.

Keywords

Kienböck's disease - adolescent Kienböck's disease - joint offloading - revascularization - bone graft

Note

All work was performed at the Mayo Clinic, Rochester, MN.

Ethical Approval

Institutional ethics committee approved the use of personal health data.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent was obtained from all patients included in the study.

• References

• 1 Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienböck's disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am 1977; 59 (07) 899-908
• 2 Ferlic RJ, Lee DH, Lopez-Ben RR. Pediatric Kienböck's disease: case report and review of the literature. Clin Orthop Relat Res 2003; (408) 237-244
• 3 Lichtman DM, Pientka II WF, Bain GI. Kienböck disease: moving forward. J Hand Surg Am 2016; 41 (05) 630-638
• 4 Hurley RT, McKee MD. Kienböck's disease: an unusual cause of wrist pain in a 13-year-old girl. Can J Surg 2008; 51 (01) E13-E14
• 5 Afshar A. Kienböck disease in the skeletally immature patient. J Hand Surg Am 2018; 43 (05) 465-469
• 6 Lichtman DM, Pientka II WF, Bain GI. Kienböck disease: a new algorithm for the 21st century. J Wrist Surg 2017; 6 (01) 2-10
• 7 Nakamura R, Tsuge S, Watanabe K, Tsunoda K. Radial wedge osteotomy for Kienböck disease. J Bone Joint Surg Am 1991; 73 (09) 1391-1396
• 8 Youm Y, McMurthy RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg Am 1978; 60 (04) 423-431
• 9 Weiss AP, Weiland AJ, Moore JR, Wilgis EF. Radial shortening for Kienböck disease. J Bone Joint Surg Am 1991; 73 (03) 384-391
• 10 Matsuhashi T, Iwasaki N, Oizumi N, Kato H, Minami M, Minami A. Radial overgrowth after radial shortening osteotomies for skeletally immature patients with Kienböck's disease. J Hand Surg Am 2009; 34 (07) 1242-1247
• 11 Irisarri C, Kalb K, Ribak S. Infantile and juvenile lunatomalacia. J Hand Surg Eur Vol 2010; 35 (07) 544-548
• 12 Kim T, Culp RW, Osterman AL, Bednar JM. Kienbock's disease in children. Jefferson Ortho J 1996; 25: 53-57
• 13 Docquier PL, Traore A, Hugon S. Kienböck's disease in a 6-year-old boy. Acta Orthop Belg 2009; 75 (06) 832-835