A systematic review of the etiopathogenesis of Kienböck's disease and a critical appraisal of its recognition as an occupational disease related to hand-arm vibration

Abstract

BackgroundWe systematically reviewed etiological factors of Kienböck’s disease (osteonecrosis of the lunate) discussed in the literature in order to examine the justification for including Kienböck’s disease (KD) in the European Listing of Occupational Diseases.MethodsWe searched the Ovid/Medline and the Cochrane Library for articles discussing the etiology of osteonecrosis of the lunate published since the first description of KD in 1910 and up until July 2012 in English, French or German. Literature was classified by the level of evidence presented, the etiopathological hypothesis discussed, and the author's conclusion about the role of the etiopathological hypothesis. The causal relationship between KD and hand-arm vibration was elucidated by the Bradford Hill criteria.ResultsA total of 220 references was found. Of the included 152 articles, 140 (92%) reached the evidence level IV (case series). The four most frequently discussed factors were negative ulnar variance (n=72; 47%), primary arterial ischemia of the lunate (n=63; 41%), trauma (n=63; 41%) and hand-arm vibration (n=53; 35%). The quality of the cohort studies on hand-arm vibration did not permit a meta-analysis to evaluate the strength of an association to KD. Evidence for the lack of consistency, plausibility and coherence of the 4 most frequently discussed etiopathologies was found. No evidence was found to support any of the nine Bradford Hill criteria for a causal relationship between KD and hand-arm vibration.ConclusionsA systematic review of 220 articles on the etiopathology of KD and the application of the Bradford Hill criteria does not provide sufficient scientific evidence to confirm or refute a causal relationship between KD and hand-arm vibration. This currently suggests that, KD does not comply with the criteria of the International Labour Organization determining occupational diseases. However, research with a higher level of evidence is required to further determine if hand-arm vibration is a risk factor for KD.

External and internal bone micro‐architecture in normal and Kienböck's lunates: A whole‐bone micro‐computed tomography study

“…In the present study, the internal and external microarchitecture of entire control lunates and lunates with Kienböck's disease has been quantified and compared, in 3D at high resolution. Previous research has focussed on avascular necrosis of other bones such as the scaphoid, or other anatomical sites such as the femoral head, while little has been published on trabecular changes in lunates affected by Kienböck's disease …”

“…Kienböck's disease is idiopathic lunate bone osteonecrosis, leading to lunate fracture and carpal collapse. The aetiology of Kienböck's disease is poorly understood, with intrinsic and extrinsic factors likely to contribute. Reported intrinsic factors are negative ulnar variance, excessive radial inclination, trapezoidal lunate shape and lunate trabecular orientation, as well as variations in vasculature .…”

Radiological characteristics of Kienböck’s disease in the Korean population

“…A negative ulnar variance (UV), primary arterial ischemia, trauma, and hand-arm vibration are considered possible risk factors for Kienböck's disease, and among these risk factors, negative UV appears to be the most commonly reported risk factor. 2 In fact, since Hulten first reported the relationship between negative UV and Kienböck's disease, 3 several studies have confirmed this relationship. [4][5][6][7] However, some studies have reported contrasting results.…”

Kienbock Disease; the Length of Capitate and Third Metacarpal Bones

“…Among the most important reasons discussed in the literature so far, negative ulnar variance, arterial ischemia, trauma and occupational factors are considered as the etiology of KD more than others (2). Nevertheless, none of these factors is proven or rejected.…”