Pain in the medial wrist following fall on an outstretched hand
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There is evidence of sclerosis and flattening of the lunate with bony fragmentation. Osteonecrosis is highly suggestive of lunate avascular necrosis, known as Kienböck disease. This was long-standing in this case.
Kienböck disease is another name for avascular necrosis, characterised by fragmentation and collapse of the lunate carpal bone as seen in this case. It is most likely related to a previous trauma component of the wrist in the which the lunate blood supply is interrupted resulting in subsequent avascular necrosis and this classic radiographic appearance.