KEINBOCK’S DISEASE

METAPHYSEAL CORE DECOMPRESSION OF DISTAL RADIUS-A NOVEL TECHNIQUE TO TREAT

Abstract

Objectives: 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).