An international opinion research survey of the etiology, diagnosis, therapy and outcome of Kienböck's disease (KD).

OBJECTIVES: Every fourth publication on Kienböck's disease (KD) is based for the most part on rather divergent expert opinion. We therefore surveyed expert opinion on KD in three European countries: (1) for the suspected aetiologies; (2) routinely used diagnostic tools; (3) recommended treatment and (4) expected outcome. METHODS: A questionnaire consisting of 16 questions was handed out at the national meetings for surgery of the hand in Germany (DE), France (FR) in 2009 and in the United Kingdom (UK) in 2010. RESULTS: Among the 126 surgeons who participated in the survey, 82 had a national diploma for surgery of the hand. None of the most commonly discussed etiopathological hypotheses were estimated as being very likely. Hand/arm vibration exposure was considered less likely among respondents in France and the UK than among respondents in Germany. Treatment recommendations are very heterogeneous for stage IIIB according to Lichtman. CONCLUSIONS: Expert opinions on diagnostic criteria, the pathogenesis and the choice of treatment are not consistent and may vary from one country to another.

[100 years after Kienböck's description: review of the etiology of Kienböck's disease from a historical perspective]. / 100 Jahre nach Kienböck: Literaturübersicht über die Ursachenforschung der Mondbeinnekrosen.

Kienböck's disease (KD) leads to collapse of the lunate bone with severe consequences for the wrist function which for some patients may result in occupational invalidity. The many synonyms of KD (aseptic necrosis or avascular necrosis) insinuate that the true etiopathology remains poorly understood. This reviews aims at exploring the level of evidence which brought forward the different hypotheses on the origin of KD. The widespread theories about the origin were formed about 100 years ago but a specific therapy is still not within reach. Although the cause of the disease remains essentially unknown it is officially recognized as an occupational disease in Germany. Empirical attempts to explain the etiopathology are based on compression of the lunate, impaired vascularity through vibration exposition, fracture and dislocation of the lunate from the radiolunate fossa. The level of evidence urges a cautious interpretation of currently discussed hypotheses on the etiology of KD.