This protocol addresses Kienbock disease presenting in patients aged 16 to 20 years — a distinct prognostic group that requires a different management pathway from both younger children and adult patients.
Patients in the 16–20 age range represent a separate prognostic category in Kienbock disease management. Because skeletal maturity and physeal status vary within this window, the therapeutic decision depends on individual anatomy and the duration and progression of symptoms. An initial trial of nonoperative management is considered for this age group.
When symptoms persist beyond three months or disease progresses despite nonoperative measures, the structured protocol directs clinicians toward lunate unloading procedures — surgical interventions tailored to the patient's ulnar variance and physeal status. The specific choice of procedure depends on individual anatomical factors addressed within the full protocol.
DOI: 10.1055/s-0037-1604137
A2 16–20 years: Trial of nonoperative management.
As these are different prognostic groups, we have separated them from the start.
Consider unloading procedure for symptoms > 3 months.
Irisarri et al recommended immobilization for patients under 15 years, and joint leveling procedures in the older patient, if there was a disease progression despite immobilization.
Temporary pinning of the STT joint unloads the lunate, and allows time for revascularization.
It is a good option as a primary treatment in the “Teenbock” patient and to protect the lunate in conjunction with a vascularized bone graft.
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