Kienbock ’ s disease following pellet injury to the lunate : A case report

Kienbock’s disease (lunatomalacia), first described by Robert Kienbock as ligamentous trauma to the lunate resulting in the interruption of internal arterial supply to the bone [1], is defined as a specific form of avascular osteonecrosis affecting the lunate. Kienbock’s disease is characterized by sclerosis, cystic changes, fragmentation, and articular surface collapse as present on plain radiographs [2,3]. Kienbock’s disease is a rare condition with an unknown etiology [2,3], seen more in manual laborers and athletes. Due to its unknown etiology the management is highly controversial with both conservative and operative management alleviating pain, improving function, and limiting the progression of the disease [2,3]. It can resemble a scapholunate sprain, lunate fracture, or lunate dislocation, which can make differentiating this condition from other wrist conditions a challenge for many healthcare practitioners. In our case, the etiology could possibly be ascribed to a pellet embedded in the lunate following a grenade blast. This has not been reported in the literature till date.