Pediatric and Juvenile Lunatomalacia: To Treat Surgically or Not? A Systematic Review and Personal Experience.

Abstract

Background: Pediatric or juvenile lunatomalacia is still a less understood disease of childhood or young adolescence with spontaneous lunate osseous alterations and sometimes incomplete reconstitution of the lunate shape and bony structure. The treatment regimen to be used is still unclear. Given the young age of the patients, the question arises whether surgery is beneficial.

Methods: We performed a systematic literature review and analysis. We included studies from the last 5 decades addressing this issue and included additional publications identified through manual screening of references. Data were collected from public bibliographic databases.

Results: We included a total of 37 studies in this article. No studies of higher levels of evidence were available. Almost all were case reports or case series, but the quality was overall rated good in most cases. Adding our case to the available studies with a focus on the treatment results, the survey and statistical analysis revealed that a conservative approach most likely results in the best outcomes until the age of 15 years.

Conclusions: Our systematic review of this topic demonstrated a lack of high-quality studies. Only reports and smaller case series were found to provide answers. The total number of patients with this entity is also low, but this work is the most comprehensive review of reported cases in the literature. Considering all these reports and our case, we recommend a conservative approach until the age of 15 years.