Kienbock's disease (avascular necrosis of the semilunar bone): treatment with Graner's technique

Abstract

Background: Osteomalacia of the lunate is the result of a traumatic interruption of the blood supply to that bone, with a subsequent disturbance of its nutrition, characterizing Kienböck's Disease (KD). The etiology of the disease is still controversial, and among the main theories about the mechanism for the development of lunate osteonecrosis include primary compression fracture, traumatic rupture of the lunate extra-osseous blood supply and repetitive loading of the bone, in addition to the presence of plungers. Aim: To describe a case of KD surgically treated in our Service through resection of the proximal row of the wrist followed by arthrodesis. Method: This is a single case report of a patient treated at the Orthopedics and Traumatology Service of Hospital Ana Costa, located in the city of Santos – SP, Brazil. Case Report: Male patient, 40 years old, Caucasian, rural worker, was admitted to our Service with a report of pain in the right wrist, dominant hand of the patient, and functional limitation. She reported a history of previous wrist trauma, however without surgical treatment. After clinical evaluation and with the advent of radiographic images, the team arrived at the diagnosis of KD. Surgical treatment was then performed, which consisted of a large resection of the proximal row of the wrist associated with an wrist arthrodesis. Conclusion: The technique used was successful for the treatment of KD in the patient reported here, without the occurrence of complications or any intercurrences that discredit its use.