Kienbock’s Disease and Other Osteonecrosis of the Pediatric Carpus

Avascular necrosis of the carpal bones is rare, especially in the pediatric population. Osteonecrosis of the lunate, i.e., Kienbock’s disease, is the carpal bone most frequently affected. Still, 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 for avascular necrosis of the carpal bones remain controversial. Similar to adults, pediatric and adolescent patients usually present with the chief complaint of wrist pain. The modality of treatment depends on both disease stage and, in the case of Kienbock’s disease, ulnar variance. The prognosis in young patients compares favorably to adults, and conservative measures are the mainstay of initial treatment. Surgical treatment is reserved for disease refractory to several months of conservative management and consists of numerous techniques, including arthroscopic debridement, joint leveling procedures, and vascularized bone grafting, among others. Surgical treatment outcomes are encouraging, and complications are generally less frequent than those observed in adults. Salvage procedures such as proximal row carpectomy or partial/total wrist arthrodesis are rarely used as the last resort procedures for patient’s that have developed end-stage painful arthritis.