case_images: PMC4764308_01
case_images: PMC4764308_02
case_images: Lateral radiographs wrist showed a densification of the lunate with a flattened and irregular appearance of the lunate, without signs of osteoarthritis
case_images: PAMJ-22-246-g001.jpg
case_images: PMC4764308_02_PAMJ-22-246-g001.jpg
case_images: F0001
case_images: Grip strength was 10 kg on the dominant left side compared with 20 kg on the right.On standard PA and lateral radiographs wrist showed a densification of the lunate with a flattened and irregular appearance associated with a fixed rotation of the scaphoid, without signs of osteoarthritis.The diagnosis was made of stage III Kienbock's disease according to Lichtman's classification (Figure 1).
case_images: MRI of the left wrist: (A) sagital protons density showing collapse of the lunate with mixesd signal intensity; (B) sagital T2-weighted fat-suppressed MR image showing fragmented and irregular appearance of the lunate with hyper signal intensity; (C) coronal STIR showing fragmented and irregular appearance of the lunate with hyper signal intensity
case_images: PAMJ-22-246-g002.jpg
case_images: PMC4764308_02_PAMJ-22-246-g002.jpg
case_images: F0002
case_images: STIR associated with a thickening of the subcutaneous soft tissue and minimal effusion at the styloid recess (Figure 2). Surgical treatment option was refused by the patient and his parents.