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Kienbock’s Disease

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The Pediatric Upper Extremity

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Abstract

Kienbock’s disease is the eponym used to describe spontaneous osteonecrosis of the lunate. This disease is rare in pediatric and adolescent patients and accounts for 1 % of all patients with Kienbock’s disease. The etiology, pathophysiology, and treatment remain controversial. Similar to adults, pediatric and adolescent patients usually present with the chief complaint of dorsal-sided wrist pain. The modality of treatment depends on both disease stage and ulnar variance. The prognosis in young patients compares favorably to adults, and conservative treatment has been known to improve outcomes even in late stage disease where the lunate has collapsed and a flexion deformity of the scaphoid has ensued. Surgical treatment is reserved for disease refractory to several months of conservative treatment and consists of numerous techniques, including arthroscopic debridement, temporary scaphotrapezial pinning, vascularized bone graft transfers, or radial shortening osteotomy. Surgical treatment outcomes are also encouraging, and complications are generally less frequent than those observed in adults. Salvage procedures such as proximal row carpectomy or total wrist arthrodesis are rarely used as the last resorts once the patient has developed end-stage painful arthritis.

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Authors and Affiliations

  1. UPMC Hamot, Department of Orthopaedic Surgery, Erie, PA, USA

    Dr. Abdo Bachoura

  2. The Philadelphia Hand Center, 834 Chestnut Street, Suite G114, 19107, Philadelphia, PA, USA

    Dr. Sidney M. Jacoby & Dr. Eon K. Shin

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  1. Dr. Abdo Bachoura
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  2. Dr. Sidney M. Jacoby
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  3. Dr. Eon K. Shin
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Correspondence to Abdo Bachoura .

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Editors and Affiliations

  1. Dept. of Orthopedics, U. of Maryland School of Medicine, Timonium, Maryland, USA

    Joshua M. Abzug

  2. Shriners Hospital for Children - Phila., Philadelphia, Pennsylvania, USA

    Scott Kozin

  3. Shriners Hospital For Children - Phila., Philadelphia, Pennsylvania, USA

    Dan A. Zlotolow

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Bachoura, A., Jacoby, S.M., Shin, E.K. (2014). Kienbock’s Disease. In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8758-6_80-1

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