A Scoping Review of Pediatric Kienböck Disease: What Do We Know?

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.