Current Trends in Treatment of Kienböck Disease

Abstract

Background: The cause and treatment of Kienböck disease is controversial. No treatment algorithm has been accepted. We surveyed US hand surgeons to determine trends and attitudes regarding the treatment of Kienböck disease. Methods: An online questionnaire was created focusing on specific treatments of Kienböck disease. The survey included 6 questions regarding the cause of disease, preferred vascularized bone grafting (VBG) procedure, and treatment of stages I, II, IIIA, and IIIB. Respondents were also asked to specify their geographic location of practice and the approximate number of years in practice. Results: A total of 338 of the 2781 surgeons contacted completed the survey for a response rate of rate of 12%. The majority of respondents believe ulnar-negative variance alone contributes to the development of Kienböck disease. For treatment of a young ulnar-neutral male with stage I disease who had failed immobilization and nonsteroidal anti-inflammatory drugs, most hand surgeons chose distal radius core decompression. There was no preferred treatment among respondents for treatment of a young ulnar-neutral female with stage II disease. For treatment of a 40-year-old ulnar-negative male with stage IIIA disease, most hand surgeons chose a radial shortening osteotomy. The preferred treatment among respondents for treatment of stage IIIB disease is a proximal row carpectomy. Conclusions: Our study demonstrated that most hand surgeons believe ulnar-negative variance largely contributes to Kienböck disease and the most commonly preferred VBG technique utilizes the fourth and fifth extensor compartment arteries.