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A Scoping Review of Pediatric Kienböck Disease: What Do We Know?
James Rex1,2, Eric Taleghani1,2, Melissa Previtera1
1Division of Hand Surgery, Department of Orthopedics, University of Cincinnati, Cincinnati, OH.
Insights
Kienböck disease in young patients is poorly understood due to limited research. Current literature lacks consistent data on pediatric Kienböck disease management and outcomes, necessitating further investigation.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Radiology
Background:
- Kienböck disease is a rare condition affecting the lunate bone in children and adolescents.
- Existing literature is predominantly composed of case reports and series, offering limited evidence for treatment guidelines.
- Conservative treatment with rigid immobilization is considered standard care, but operative interventions are more frequently reported.
Purpose of the Study:
- To review and assess the quality of evidence for Kienböck disease in patients under 18.
- To determine if current literature supports definitive conclusions on management and outcomes for pediatric Kienböck disease.
Main Methods:
- Comprehensive literature searches were conducted in PubMed, Scopus, and Cochrane Library.
- Studies were screened for relevance to pediatric and adolescent Kienböck disease, focusing on presentation, diagnosis, interventions, and outcomes.
- Data extraction was performed on 69 selected studies published between 1976 and 2023.
Main Results:
- The review included 69 studies, with 57 detailing surgical interventions in 142 patients and 16 reporting conservative management in 26 patients.
- Surgical approaches varied significantly, with radial shortening osteotomy being the most common procedure.
- Outcome reporting was inconsistent, primarily focusing on pain and range of motion.
Conclusions:
- The current body of literature on pediatric and adolescent Kienböck disease is characterized by heterogeneity in data collection and reporting.
- Despite conservative management being the purported gold standard, most studies focus on operative cases.
- Prospective research is essential to establish clear management protocols and expected outcomes for this condition.
Purpose:
Kienböck disease is a rare entity in pediatric and adolescent patients. The available published literature is limited primarily to case series and case reports. A trial of conservative treatment with rigid immobilization has been described as the standard of care in these cases. Our aim was to examine the body of literature regarding Kienböck disease in patients under 18 years of age to determine the quality of current evidence and whether concrete conclusions could be drawn regarding management and outcomes.
Methods:
Literature searches were run in the databases PubMed, Scopus, and Cochrane Library with keywords for terms such as osteonecrosis, lunate, and Kienböck disease. The results underwent deduplication followed by title screening, abstract screening, and full-text screening. From the resulting studies, data were extracted regarding patient presentation and diagnosis, interventions, and reported outcomes.
Results:
Five hundred twenty-seven studies were screened after removal of duplicates. Further review yielded 69 studies published from 1976 to 2023 with data specific to pediatric and adolescent Kienböck disease. In total, 57 studies detailed operative intervention in 142 patients. Sixteen studies reported isolated conservative management in 26 patients. Surgical procedures were highly variable, with radial shortening osteotomy being the most prevalent. Reported outcomes were similarly inconsistent, with pain and range of motion most documented.
Conclusions:
Publications regarding pediatric and adolescent Kienböck disease are limited primarily to case reports and case series with highly variable data collection regarding patient presentation, interventions, and outcome measures. Although conservative management with immobilization has been reported as the gold standard treatment for this condition, most literature reports operatively treated cases. A prospective investigation is needed to delineate the appropriate management and expected outcomes of pediatric and adolescent Kienböck disease.
Type Of Study/Level Of Evidence:
Differential diagnosis/symptom prevalence study 3a.
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