A Comprehensive Case Report on Kienbock's Disease: Diagnostic Hurdles and Surgical Outcomes With Proximal Row Carpectomy.

Kienbock's disease is a rare form of avascular necrosis affecting the lunate bone in the wrist, leading to progressive bone necrosis and functional impairment. The disease's rarity and nonspecific early symptoms present significant diagnostic and treatment challenges. We report the case of a 41-year-old female presenting with chronic left wrist pain and restricted movement without a history of trauma. Her symptoms had progressively worsened over 20 days. Laboratory findings showed an elevated erythrocyte sedimentation rate (ESR) of 14 mm/hour and a slightly prolonged clotting time of 3'30'', while other parameters, including C-reactive protein (CRP), electrolytes, renal function, and blood sugar levels, were within normal ranges. Radiographic imaging indicated lunate collapse, joint space narrowing, subchondral cysts, and secondary osteoarthritis, confirming the diagnosis of Kienbock's disease. Given the severity of her condition, a proximal row carpectomy (PRC) was performed, resulting in significant pain relief and improved wrist function. This case underscores the complexities in diagnosing Kienbock's disease, particularly in regions where it is rare, such as India. The Lichtman classification system was essential in guiding treatment decisions, ranging from conservative measures to surgical interventions. This report highlights the importance of accurate diagnosis and individualized treatment plans in managing Kienbock's disease, demonstrating the efficacy of PRC in advanced stages. It contributes valuable insights into the diagnostic and therapeutic strategies for this rare but impactful condition, emphasizing the need for further research into innovative therapies and preventive measures.