J Korean Orthop Assoc.  2018 Oct;53(5):453-457. 10.4055/jkoa.2018.53.5.453.

Advanced Pediatric Kienbock's Disease

• Kim DH
• Eho YJ
• Jeong M

• KMID: 2424106
• DOI: http://doi.org/10.4055/jkoa.2018.53.5.453

Abstract

Kienbock's disease is very rare in pediatrics. The treatment of Kienbock's disease is controversial and depends on an understanding of the natural history of the disease. The methods proposed vary from conservative treatment to surgical treatment such as radial shortening or scaphotrapezoidal joint fixation, but there are few therapeutic guidelines for paediatric Kienbock's disease. We encountered a 14-year-old male with Lichtman stage IIIB disease and treated him with conservative management. We report this rare case of advanced paediatric Kienbock's disease with good clinical results at the 2-year follow-up along with a review of the relevant literature.

Keyword

lunate; osteonecrosis; Kienbock's disease; adolescent

MeSH Terms

Adolescent
Follow-Up Studies
Humans
Joints
Male
Natural History
Osteonecrosis*
Pediatrics

Figure

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  Figure 1 A 14-year-old male with wrist pain due to stage IIIA Kienbock's disease. Standard anteroposterior and lateral radiographs at presentation show that the lunate has sclerotic changes with a collapse of height. A neutral ulnar variance can be seen.

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  Figure 2 (A) Sagittal computed tomography image shows bony fragmentation of the lunate bone. (B) Coronal T1-weighted magnetic resonance imaging (MRI) shows diffuse hypointensity of the lunate bone. Coronal T2-weighted fat-suppressed MRI shows diffuse hyperintensity and collapse of the lunate bone.

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  Figure 3 Anteroposterior and lateral radiographs at 12 weeks after casting. The carpal height ratio did not change, and the collapse of the lunate did not progress.

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  Figure 4 Twenty-four months after the cast was removed, the patient reported a resolution of their wrist pain and showed a preservation of some wrist motions.

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  Figure 5 Radiograph (A), magnetic resonance imaging (B) and computed tomography (C) at the last follow-up evaluation showed no recurrence of Kienbock's disease.

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