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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Stage III Kienböck’s disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition
  1. Paulo Jorge Figueira1,2,
  2. Diogo Alpuim Costa3,4,
  3. Nunzio Barbagallo5,
  4. Francisco Gamito Guerreiro4,6
  1. 1Orthopaedic Department, Centro Hospitalar de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
  2. 2Centro de Medicina Naval, Marinha Portuguesa, Almada, Portugal
  3. 3Haematology and Oncology Department, Instituto CUF de Oncologia (I.C.O.), Lisbon, Portugal
  4. 4Centro de Medicina Subaquática e Hiperbárica, Marinha Portuguesa, Marinha Portuguesa, Lisbon, Portugal
  5. 5Physics and Astronomy Department, Università di Bologna, Bologna, Italy
  6. 6Centro de Investigação Naval (CINAV), Marinha Portuguesa, Almada, Portugal
  1. Correspondence to Dr Diogo Alpuim Costa, diogo.costa{at}jmellosaude.pt

Summary

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.

  • musculoskeletal and joint disorders
  • medical management
  • orthopaedics
  • therapeutic indications
  • drugs: musculoskeletal and joint diseases

https://doi.org/10.1136/bcr-2018-226090

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    Footnotes

    • Contributors PJF, DAC, NB and FGG: planning, conduct and reporting of the work described in the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Coauthor NB is the father of the minor patient represented in the clinical case. He is a researcher in the area of Physics and Astronomy of the University of Bologna who encouraged and collaborated in all points concerning the accomplishment of the following article. The father and the patient signed the informed consent.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.