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Kienböck’s disease, an uncommon avascular necrosis of the lunate, remains challenging to manage, particularly in young adults. We report a woman in her 20s with early-stage disease (Lichtman stage II) and positive ulnar variance, but without lunate collapse. She underwent a distal radial osteotomy with autologous cancellous bone grafting, stabilised with a volar locking plate, along with intraosseous lunate decompression. Postoperative recovery was uneventful, with complete union at the osteotomy site, restoration of wrist motion and return to unrestricted activity at 1 year. This case illustrates the role of combined distal radial osteotomy and lunate decompression as a joint-preserving strategy in early Kienböck’s disease with positive ulnar variance.