Repetitive Microtrauma and Negative Ulnar Variance as Possible Culprits of Avascular Necrosis of the Lunate

Kienböck's disease is characterized by avascular necrosis of the lunate. Its pathophysiology involves a complex interplay of repetitive microtrauma, anatomical and vascular variances. Early diagnosis of this entity is challenging as disease presentation is nonspecific and can mimic common wrist pathologies such as fractured or sprained wrist. Here we report a case presentation of Kienböck's disease Stage IIIA in a 28-year-old healthy male. Initial radiographs of the left wrist were inconclusive and two weeks later the diagnosis was confirmed with a magnetic resonance imaging. The patient was initially treated with cast immobilization for four months but remained symptomatic with no improvements in pain or function. He then elected to participate in left radial shortening osteotomy with a vascularized bone graft from the distal radius. Unfortunately, both conservative and invasive procedures did not prevent end-stage disease characterized by the complete collapse of the lunate. However, 18 months post-surgical follow-up, the patient continues to remain pain-free with no limitations to his daily living activities.