{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:52:24Z","timestamp":1766119944754,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Kienb\u00f6ck\u2019s disease, an uncommon avascular necrosis of the lunate, remains challenging to manage, particularly in young adults. We report a woman in her 20s with early-stage disease (Lichtman stage II) and positive ulnar variance, but without lunate collapse. She underwent a distal radial osteotomy with autologous cancellous bone grafting, stabilised with a volar locking plate, along with intraosseous lunate decompression. Postoperative recovery was uneventful, with complete union at the osteotomy site, restoration of wrist motion and return to unrestricted activity at 1 year. This case illustrates the role of combined distal radial osteotomy and lunate decompression as a joint-preserving strategy in early Kienb\u00f6ck\u2019s disease with positive ulnar variance.<\/jats:p>","DOI":"10.1136\/bcr-2025-268858","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:05:30Z","timestamp":1766117130000},"page":"e268858","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Joint-preserving management of Kienb\u00f6ck\u2019s disease"],"prefix":"10.1136","volume":"18","author":[{"given":"Alok Chandra","family":"Agrawal","sequence":"first","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgardh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0584-3384","authenticated-orcid":false,"given":"Shivam","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgardh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harshal","family":"Sakale","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgardh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0628-648X","authenticated-orcid":false,"given":"Rakesh","family":"Dhaka","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgardh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2025121820052277000_18.12.e268858.1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1055\/s-0037-1604137","article-title":"Addendum: Kienb\u00f6ck Disease: A New Algorithm for the 21st Century","volume":"06","author":"Lichtman","year":"2017","journal-title":"Jnl Wrist Surg"},{"key":"2025121820052277000_18.12.e268858.2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s00132-018-3641-5","article-title":"Kienb\u00f6ck\u2019s disease with non-negative ulnar variance\u202f: Treatment with combined radial wedge and shortening osteotomy","volume":"48","author":"Hong","year":"2019","journal-title":"Orthopade"},{"key":"2025121820052277000_18.12.e268858.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-200111000-00004"},{"key":"2025121820052277000_18.12.e268858.4","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1097\/PRS.0b013e31829f4a2c","article-title":"Critical analysis of causality between negative ulnar variance and Kienb\u00f6ck disease","volume":"132","author":"Stahl","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2025121820052277000_18.12.e268858.5","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.2106\/JBJS.17.00764","article-title":"Long-term outcomes of nonoperative and operative treatment of Kienb\u00f6ck disease: a systematic review","volume":"100","author":"Shin","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"2025121820052277000_18.12.e268858.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(82)80147-0"},{"key":"2025121820052277000_18.12.e268858.7","first-page":"203","article-title":"Radiocarpal wedge osteotomy in Kienb\u00f6ck disease: a systematic review","volume":"5","author":"Heifner","year":"2023","journal-title":"J Hand Surg Glob Online"},{"key":"2025121820052277000_18.12.e268858.8","article-title":"Clinical and Radiographic Outcomes in Kienbock Disease Following Radial Closing Wedge Osteotomy: An Age Comparative Study and Literature Review","volume":"9","author":"Yokota","year":"2024","journal-title":"JB JS Open Access"},{"key":"2025121820052277000_18.12.e268858.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(03)00490-8"},{"key":"2025121820052277000_18.12.e268858.10","doi-asserted-by":"crossref","first-page":"105090","DOI":"10.1016\/j.clinbiomech.2020.105090","article-title":"Lunate loads following different osteotomies used to treat Kienb\u00f6ck\u2019s disease: A 3D finite element analysis","volume":"78","author":"Camus","year":"2020","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"2025121820052277000_18.12.e268858.11","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1055\/s-0036-1581099","article-title":"Long-term outcomes of radial osteotomy for Kienb\u00f6ck disease","volume":"5","author":"Tatebe","year":"2016","journal-title":"J Wrist Surg"},{"key":"2025121820052277000_18.12.e268858.12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/BLO.0b013e318041d309","article-title":"Outcome of Kienb\u00f6ck\u2019s disease 22 years after distal radius shortening osteotomy","volume":"460","author":"Raven","year":"2007","journal-title":"Clin Orthop Relat Res"},{"key":"2025121820052277000_18.12.e268858.13","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1016\/j.jhsa.2012.07.023","article-title":"Osteotomy of the radius without shortening for Kienb\u00f6ck disease: 10-year follow-up","volume":"37","author":"Blanco","year":"2012","journal-title":"J Hand Surg Am"},{"key":"2025121820052277000_18.12.e268858.14","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1053\/jhsu.2001.22928","article-title":"The surgical treatment of Kienb\u00f6ck\u2019s disease by radius and ulna metaphyseal core decompression","volume":"26","author":"Illarramendi","year":"2001","journal-title":"J Hand Surg Am"},{"key":"2025121820052277000_18.12.e268858.15","doi-asserted-by":"crossref","unstructured":"Kamrani RS , Karimi A , Afshar A , et al . Arthroscopic lunate core decompression provides similar early clinical outcomes to open radial shortening osteotomy in Kienb\u00f6ck disease. J Hand Surg Am 2022;47. doi:10.1016\/j.jhsa.2021.07.019","DOI":"10.1016\/j.jhsa.2021.07.019"},{"key":"2025121820052277000_18.12.e268858.16","first-page":"234","article-title":"Improvement in lunate perfusion after radial closing-wedge osteotomy using gadolinium-enhanced MRI","volume":"40","author":"Lee","year":"2021","journal-title":"Hand Surg Rehabil"},{"key":"2025121820052277000_18.12.e268858.17","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.2106\/JBJS.24.01090","article-title":"Kienb\u00f6ck Disease: Recent Advances in Understanding and Management","volume":"107","author":"Lichtman","year":"2025","journal-title":"J Bone Joint Surg Am"},{"key":"2025121820052277000_18.12.e268858.18","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/1753193421999915","article-title":"Capitate shortening osteotomy and vascularized bone grafting for Kienb\u00f6ck\u2019s disease in ulnar positive or neutral wrists","volume":"46","author":"Hunter","year":"2021","journal-title":"J Hand Surg Eur Vol"},{"key":"2025121820052277000_18.12.e268858.19","first-page":"3","article-title":"Vascularized bone grafting in Kienb\u00f6ck disease: a systematic review","volume":"18","author":"Heifner","year":"2023","journal-title":"Hand (N Y)"},{"key":"2025121820052277000_18.12.e268858.20","first-page":"515","article-title":"Current concepts in vascularized bone grafting for Kienb\u00f6ck\u2019s disease","volume":"47","author":"Patel","year":"2022","journal-title":"J Hand Surg Am"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268858","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:05:32Z","timestamp":1766117132000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,18]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bcr-2025-268858"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268858","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}