We report a case of cartilage destruction of the lunate bone caused by gouty tophus, treated with a medial femoral trochlear osteochondral flap. The patient was a 45-year-old man presenting with swelling and pain in the right wrist. Radiography and computed tomography revealed bone erosion and marginal sclerosis of the lunate. Based on these findings, Kienböck’s disease (Lichtman stageⅢA) was suspected, and surgical intervention was planned. Intraoperatively, a white, chalk-like substance was observed upon joint incision. The proximal articular surface of the lunate was removed and sent for pathological examination. Using a preoperatively constructed three-dimensional bone model for guidance, an osteochondral flap was harvested from the medial femoral trochlea and transplanted to reconstruct the proximal cartilage surface of the lunate. Pathological examination showed no evidence of bone necrosis but revealed eosinophilic fibrous deposits surrounded by foreign body giant cells, consistent with gouty tophus. Postoperatively, the symptoms resolved, and the osteochondral flap was successfully integrated.
