Faaiz Ali Shah, Waqar Alam, Sikandar Hayat, Ashfaq Ahmed, Saeed Ahmad, Shahzad Javed, Amer Aziz.
Keinbock’s disease; metaphyseal core decompression of distal radius-a novel technique to treat.
Professional Med J Jan ;23(09):1127-31.

To evaluate the functional and radiological outcome of metaphyseal core decompression of distal radius for treating Keinbock’s disease. Study Design: Descriptive case series. Place and Duration: Orthopaedic A Unit Lady Reading Hospital Peshawar and Ghurki Trust Teaching Hospital, Lahore and District Headquater Hospital Temargarah Lower Dir from January 2014 to June 2016. Material and Methods: Patients of all ages and both gender with pain and restricted wrist motion and radiologically diagnosed Lichtman’s stage I, II and III (A) were included in the study. Metaphyseal core decompression of distal radius was performed in the included subjects and patients were followed fortnightly for two months and then monthly for at least one year. At each visit pain was assessed with Visual Analogue Scale (VAS), wrist flexion and extension measured with goniometer and Stahl index with x ray wrist. Results: A total of eleven patients including 9(81.8%) males and 2(18.1%) females with \mean age 31.2 years (range 24 to 42 years) were included in the study. Lichtman’s stage I patients were 2(18.1%), stage II were 6(54.5%) while stage III (A) patients were 3(27.2%).Post operatively complete pain relief was achieved (VAS 0) for all stage I and II and most stage III (A) patients (90.9%, n=10) while mild pain (VAS 1) was reported in one (9%) patient of stage III (A) disease at final visit. Normal wrist flexion and extension was achieved in all stage I and II and most of stage III (A) patients (90.9%). Only one (9 %) patient of stage III (A) could not achieve adequate wrist mobility at last follow up. Pre and post op Stahl index remained the same for all stages. No complication was reported. Conclusion: Metaphyseal core decompression of distal radius results in excellent functional outcome in majority patients and should be the treatment of choice for early Keinbock’s disease (stage I’II and III (A).

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com