Combined Vascularised Bone Graft Techniques for Displaced Coronal Fracture in Kienböck Disease: A Case Report

Surgical treatment of Kienböck disease remains controversial and depends on patient age, activity and disease stage. We report an 18-year-old female badminton player who presented with wrist pain, limited motion and decreased grip strength. Imaging revealed a displaced coronal lunate fracture, with the palmar fragment locked against the volar rim of the radius, consistent with Lichtman Stage IIIC and Bain grade 2b. MRI showed low signal intensity, suggesting compromised vascularity. Arthroscopy confirmed intact cartilage except at the fracture site. Lunate reconstruction using the Kuhlmann technique with a vascularised bone graft was performed, and the scaphoid was temporarily fixed to the radius to offload the lunate. At 2-year follow-up, despite the development of radiolunate osteoarthritis, the patient showed significant improvement in pain, grip strength and wrist motion. This case highlights that although disease progression may continue, joint-preserving reconstruction can achieve favourable functional outcomes in young, active patients. Level of Evidence: Level V (Therapeutic)