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Introduction: There is no definitive evidence of the superiority of any single treatment for Kienböck’s disease, the pathophysiology and natural history of which are poorly understood. We created a survey to assess the current practices of hand surgeons in the management of Kienböck’s disease at all stages. We hypothesize that hand surgeons will have widely varying strategies in their approaches to treatment.

Methods: An anonymous online survey with hypothetical cases stratified by the Lichtman staging system was distributed to 2,100 members of the American Society for Surgery of the Hand. Participants were presented with multiple-choice questions with standard answers reflecting the currently accepted breadth of treatment options. Statistical tests for significance (p<0.05) were performed between demographic groups with the Chi-square test.

Results: A total of 375 surgeons representing a wide variety of demographic backgrounds participated in the survey, of whom 90% report using the Lichtman staging to guide their treatment. For stage I disease, 69% would trial splinting or cast immobilization, for an average of 7 weeks. If immobilization were unsuccessful, 51% would then perform a radial shortening osteotomy, regardless of ulnar variance. For stage II Kienböck’s disease, 28% of participants would still trial splinting first. Among the 72% who chose surgery, the most common procedure was radial shortening osteotomy. For stage IIIa Kienböck’s with 3mm negative ulnar variance, 64% opted for radial shortening osteotomy, most commonly to an ulnar variance of 0mm. The treatment of stage IIIa Kienböck’s with positive ulnar variance was heterogeneous, with capitate shortening osteotomy (25%) and vascularized bone graft (16%) being the most commonly chosen treatments. 90% of participants report altering their treatment strategy depending upon ulnar variance. For stage IIIb Kienböck’s, 68% went immediately to salvage procedures, including proximal row carpectomy (39%), intercarpal arthrodesis (19%), and total wrist fusion (10%). If imaging showed arthritic changes akin to stage IV Kienböck’s, 44% of respondents would change their management strategy, and of these, 94% chose either PRC or wrist fusion.

Conclusion: When treating for Kienböck’s disease, the majority of survey participants use Lichtman staging and ulnar variance to guide treatment decisions. Overall, the most common surgical treatments were radial shortening osteotomy followed by proximal row carpectomy. Despite differences in individual surgeon backgrounds and the number of treatment options described, our results establish treatments used by the majority of hand surgeons for each stage of Kienböck’s disease.