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Surgical Management and Outcomes of Pediatric Kienböck's Disease: A Review of Intervention Strategies
Kala T. Pham, BS
1, Juston Fan, DO
1, Umar M. Ghilzai, MD
1, William Leavitt, MD
1, Bryce Bell, MD
2; Christine Yin, MD
1(1)Baylor College of Medicine, Houston, TX, (2)Texas Children's Hospital, Houston, TX
Introduction: The current recommendation is to treat pediatric Kienböck's disease nonoperatively with limited data on its surgical management. We strived to assess radiographic and clinical outcomes of pediatric Kienböck's disease treated operatively versus nonoperatively.
Materials and Methods: A retrospective review was performed at a single large, tertiary-care referral center and regional level 1 pediatric trauma hospital. Patients under 20 years of age diagnosed with Kienböck's disease between January 2014 to July 2024 were included. Sixteen patients with Kienböck's disease were identified (mean age 15.5 +/- 2.2 years). 5 underwent nonoperative management (casting), and 11 underwent surgery. Of the surgical cases, 10 had lunate offloading: 4 radial shortenings, 5 scaphocapitate pinnings, 1 radioscaphocapitate and radiolunate pinning. 8 surgical patients additionally received vascularized bone grafts. 1 patient underwent proximal row carpectomy.
Results: Nonoperative cohort: 3 Lichtman stage 1, 1 stage II and 1 stage IIIB. Average casting time was 2.2 months, with average follow-up of 10.5 months. Mean change in ulnar variance (?UV) was 0 (
p=1.00), in radioscaphoid (?RS) angle was -8.9 (
p=0.42), and in capitate radius distance (?CR index) was -0.5 (
p=0.10).
Operative cohort: 7 Lichtman stage IIIA, 2 stage IIIB and 1 stage IIIC with average follow-up of 13.2 months. Mean change in ulnar variance (?UV) was 0 (
p=0.15), in radioscaphoid (?RS) angle was -8.9 (
p=0.15), and in capitate radius distance (?CR index) was -0.5 (
p=0.05). Patients who underwent lunate offloading had ?UV of +0.4, ?RS angle of +1.4, and ?CR index of +0.2. Patients who underwent lunate offloading with vascularized bone graft had ?UV of +0.7, ?RS angle of +6.2, and ?CR index of +0.6. When comparing lunate offloading procedures to vascularized bone grafts, there was no signficant difference in ?UV (
p=1.00), ?RSA (
p=0.79), ?CR Index (
p=0.69)
Conclusion:This study presents a small series of patients who have failed conservative management and benefitted from operative intervention, suggesting that there is a role for surgery in this rare subgroup of a rare disease. Both radiographic and clinical improvement remains mixed in both the nonoperative and operative cohorts.
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