title: Prospective case-control study on the etiopathology of Kienböck disease.
abstract: BACKGROUND
  Multiple hypotheses regarding the cause of Kienböck disease have been proposed in seemingly contradictory small case series and cohort studies with inadequate statistical power. A prospective case-control study was conducted to analyze frequently discussed risk and causal factors.
  
  
  METHODS
  Eighty-one consecutive patients with Kienböck disease and 198 patients with wrist ganglia were referred to the authors' clinic between 1990 and 2012, and 2003 and 2011, respectively. Patients with wrist ganglia were chosen as a control group because of the similar age distribution compared with the general population and because the common etiopathologic features of wrist ganglia and Kienböck disease can be excluded. Demographic, occupational, and medical information, including age, sex, handedness, ethnicity, education, occupation and employment status, prior treatment, and medical history were collected. Associated conditions and medication were assessed at a follow-up examination.
  
  
  RESULTS
  Sixty-five of 81 patients with Kienböck disease and 70 of 198 controls were included in the study. Both groups were comparable with respect to age distribution and handedness. Employment status and job characteristics were similar in both groups. Hand-arm vibration during work or leisure activity over a period of 2 years was present in 23 percent with Kienböck disease and in 24 percent of 70 controls. Cortisone was used in six of 65 cases with Kienböck disease [controls, zero of 70] for an average duration of 46 months.
  
  
  CONCLUSIONS
  Trauma, hand-arm vibration, heavy manual labor, and comorbidities were not associated with Kienböck disease. Steroid-associated Kienböck disease in six of 65 cases is consistent with the findings reported for osteonecrosis of other parts of the skeleton.
  
  
  METHODS
  Risk, III.
authors.affiliation: Tübingen and Stuttgart, Germany From the Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, and the Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University Tübingen; and the Department for Plastic Surgery, Marienhospital Stuttgart.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Stahl
authors.forename: Pascal J H
authors.initials: PJH
authors.lastname: Hentschel
authors.forename: Oliver
authors.initials: O
authors.lastname: Lotter
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.forename: Theodora
authors.initials: T
authors.lastname: Manoli
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
authors.forename: Adelana Santos
authors.initials: AS
authors.lastname: Stahl
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D053421:Hand-Arm Vibration Syndrome / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000150:complications; D010020:Osteonecrosis / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids