Risk factors for Kienböck’s disease and need for surgical intervention: a nationwide register study from Finland

Introduction: This study was designed to investigate the association between previously known risk factors for other avascular necrosis disorders of bone and Kienböck’s disease and the need for surgical intervention. Methods: Details of patients with Kienböck’s disease and possible predisposing factors were obtained from multiple nationwide Finnish health registers for the period 1996–2022. Results: Men were more often affected and had a higher risk for operations, with an incidence rate ratio 1.24 (95% CI: 1.15 to 1.33) and a risk ratio of 1.16, respectively. Many previously known risk factors for other avascular necrosis were found to be associated with Kienböck’s disease, such as alcohol abuse (odds ratio (OR) 1.67), rheumatic diseases (OR 1.81), coagulopathic state (OR 1.59) and history of hand and wrist injuries (OR 3.03). Operated patients had a higher prevalence of type 1 diabetes (OR 2.43) and coagulopathic risk factors (OR 1.40). Patients requiring total wrist arthrodesis had a higher prevalence of immunosuppression (OR 1.77), cardiovascular risk factors (OR 2.31), alcohol abuse (OR 2.13), rheumatoid arthritis (OR 3.74), pancreatitis (OR 3.03) and hypertension (OR 1.94). Conclusions: Many systemic disorders were found to be associated with Kienböck’s disease. Wrist and hand injuries might also be predisposing factors. Factors such as immunosuppression, alcohol abuse and cardiovascular risk factors may increase the risk of developing a more severe form of this disease, requiring surgery. Level of evidence: III