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J Wrist Surg 2015; 04(01): 043-048
DOI: 10.1055/s-0035-1544225
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Management of Kienböck Disease: A Survey of the ASSH Membership

Jonathan R. Danoff
1   Department of Orthopaedic Surgery, Columbia University Medical Center, New York
,
Derly O. Cuellar
1   Department of Orthopaedic Surgery, Columbia University Medical Center, New York
,
Jane O.
1   Department of Orthopaedic Surgery, Columbia University Medical Center, New York
,
Robert J. Strauch
1   Department of Orthopaedic Surgery, Columbia University Medical Center, New York
› Author Affiliations
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Publication History

Publication Date:
13 February 2015 (online)

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The Management of Kienböck Disease: A Survey of the ASSH MembershipJ Wrist Surg 2015; 04(02): 148-148
DOI: 10.1055/s-0035-1550427

Abstract

Background The purpose of this study was to determine the current trends and common practices for the treatment of Kienböck disease at different stages.

Question/Purpose To determine the current trends and common practices by hand surgeons for the treatment of Kienböck disease.

Methods A survey with hypothetical Kienböck disease cases stratified by the Lichtman staging system was distributed to the American Society for Surgery of the Hand (ASSH) members. Questions and responses reflected common treatment strategies.

Results Of a total of 375 worldwide respondents, preferred treatments of Kienböck disease were as follows: for Stage I disease, an initial trial of splinting was favored (74%), followed by radial shortening osteotomy for continued symptoms. For Stage II disease, 63% of surgeons preferred surgical intervention, particularly radial shortening osteotomy. For Stage IIIa with negative ulnar variance, 69% chose radial shortening osteotomy. Responses were heterogeneous for Stage IIIa Kienböck with positive variance, and capitate shortening osteotomy and vascularized bone grafting were preferred. Salvage procedures predominated for Stage IIIb disease, including proximal row carpectomy (PRC; 42%), intracarpal arthrodesis (21%), and total wrist fusion (10.7%). Similarly, Stage IV disease was treated by 87% of respondents by either PRC or wrist fusion. Without regard to stage of disease, 90% of participants reported using the same Lichtman staging to guide treatment and would also alter treatment strategy based upon ulnar variance.

Conclusions Most respondents used Lichtman staging and ulnar variance to guide treatment decisions. Results indicate that the most common surgical treatments were radial shortening osteotomy for early disease and PRC in later stages.

Level of Evidence Level IV, Economic/Decision Analysis

Keywords

Kienböck disease - wrist - carpal - arthritis - lunate - survey - treatment - trends

Note

This study was funded by a grant from the Orthopaedic Scientific Research Foundation.


 

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