Stage III Kienböck’s disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition

• Published in: BMJ case reports Vol. 2018; p. bcr-2018-226090
• Main Authors: Figueira, Paulo Jorge, Alpuim Costa, Diogo, Barbagallo, Nunzio, Guerreiro, Francisco Gamito
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 12-10-2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Adolescent; Bone marrow; Case reports; Diagnosis, Differential; Edema; Gangrene; Gymnastics; Humans; Hyperbaric Oxygenation; Lunate Bone - diagnostic imaging; Lunate Bone - pathology; Magnetic Resonance Imaging; Male; Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation); Osteonecrosis - diagnosis; Osteonecrosis - diagnostic imaging; Osteonecrosis - therapy; Oxygen therapy; Pain; Patients; Stem cells; drugs: musculoskeletal and joint diseases; orthopaedics; musculoskeletal and joint disorders; medical management; therapeutic indications
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-226090

Kienböck’s disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck’s disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck’s disease treated with hyperbaric oxygen.