Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures
Joshua A Gillis1, Joseph S Khouri1, Steven L Moran1,2
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Journal of Wrist Surgery
|June 9, 2020
Summary
Surgical management of Kienböck's disease in adolescents offers good outcomes after conservative treatments fail. Both lunate offloading and revascularization procedures showed similar improvements in grip strength and motion.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hand surgery
Background:
- Kienböck's disease is a condition affecting the lunate bone in the wrist.
- Adolescent cases often require surgical intervention when non-operative treatments are unsuccessful.
Purpose of the Study:
- To assess surgical outcomes and complications in adolescents with Kienböck's disease.
- To compare the efficacy of lunate offloading versus revascularization procedures.
Main Methods:
- Retrospective review of 21 wrists in 20 adolescent patients surgically treated between 1990 and 2016.
- Data collected included demographics, trauma history, range of motion, grip strength, and radiographic parameters.
- Comparison between lunate offloading (e.g., radial-shortening osteotomy) and revascularization techniques.
Main Results:
- All patients experienced minimal to no pain at a mean follow-up of 63.4 months.
- Postoperative grip strength and radial deviation improved in both surgical groups, with no significant difference.
- Lunate offloading procedures resulted in less ulnar variance; revascularization was confirmed by MRI in 8/11 patients.
Conclusions:
- Surgical treatment is a viable option for adolescent Kienböck's disease refractory to conservative care.
- Both offloading and revascularization techniques can lead to satisfactory functional recovery.
- Further research may elucidate long-term differences between surgical approaches.
