RADIAL SHORTENING OSTEOTOMY FOR SYMPTOMATIC STAGE 3 KEINBOCKS DISEASE. PATIENT RELATED 1-YEAR OUTCOMES

Asad Ullah Jan, Sajjad Ahmed, Sajjad Khan, Abdullah Khan, Jahandad Anwer, Sidra Tul Muntaha, Muhammad Shoaib Khan

Abstract


Background: Keinbock’s disease, also known as lunatomalacia or avascular necrosis of the lunate first described by Austrian Robert Keinbock in 1910, is a relatively rare condition affecting the wrist. Its epidemiology varies across different populations and regions, and several factors contribute to its occurrence. Keinbock’s disease is considered relatively rare, with an estimated annual incidence of 1-3 cases per 100,000 individuals. Treatment strategies range from lunate-preserving techniques in early stages to salvage procedures in advanced stages. This study focuses on Stage 3 Keinbock’s disease patients without osteoarthritic signs, evaluating the efficacy of radial shortening osteotomy in improving patient outcomes.

Materials & Methods: This descriptive study was conducted in a District Headquarter teaching hospital Bannu, KPK and Lady Reading Hospital Peshawar KPK from January 2023 to June 2023. All the cases were performed by one of the Hand surgery fellows. The study was approved by Hospital ethical committee. Between 2018 and 2022 all the cases of keinbocks disease treated by radial shortening osteotomy meeting the inclusion criteria were included in the study.

Results: There were 12 patients in this study with keinbocks disease. Out of these, 5 were males and 7 were females. Right side was predominantly involved and no patients had bilateral disease. Average follow up was more than 12 months for each case. Physiological and radiological parameters were assessed both preoperatively and post operatively using standardized protocol. Pain improved significantly, which was severe in 7 cases and moderate in 5 cases, postoperatively was present mildly in 2 cases. Grip strength which was 45-60 % preoperatively improved to 80 -90% postoperatively. Similarly, loss of wrist ROM also improved dramatically almost to normal. There was much less effect on the radiology of the patients. Lunate sclerosis remained the same. Only one case developed arthritis after one year of surgery but he had no pain and needed no further treatment.

Conclusion: Radial shortening osteotomy for Stage 3 Keinbock’s disease appears promising based on our 1-year follow-up results.


Keywords


Keinbocks disease; radial shortening osteotomy; lunate avascular necrosis.

Full Text:

PDF

References


Wang PQ, Matache BA, Grewal R, Suh N. Treatment of stages IIIA and IIIB in Keinbock's disease: a systematic review. J Wrist Surg. 2020;9(6):535e548. https://doi.org/10.1055/s-0040-1716353

van Leeuwen WF, Pong TM, Gottlieb RW, Deml C, Chen N, van der Heijden BEPA. Radial shortening osteotomy for symptomatic Keinbock's disease: complications and long-term patient-reported outcome. J Wrist Surg. 2021;10(1):17e22. https://doi.org/10.1055/s-0040-1714750

Kayaokay K, Ozcan C, Bulut T, Gursoy M, Mete BD. Radial shortening osteotomy vs partial capitate shortening osteotomy in Keinbock's disease: medium-term radiological and clinical results. Hand Surg Rehabil. 2021;40(4):427e432. https://doi.org/10.1016/j.hansur.2021.03.004

Unal KO, Bingol O, Korucu A, Kilic E, Ozdemir G, Akinci M. Medium-term clinical and radiological results of surgically treated stage 3A Keinbock's disease. Hand Surg Rehabil. 2021;40(6):737e743. https://doi.org/10.1016/j.hansur.2021.07.002

Shiota J, Momma D, Matsui Y, Inoue N, Kondo E, Iwasaki N. Changes in wrist joint contact area following radial shortening osteotomy for Kienbock's disease. Sci Rep. 2022;12(1):4001. https://doi.org/10.1038/s41598-022-08027-0

Lee JH, Kim J, Hwang JS, Baek GH. Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Keinbock's disease. Hand Surg Rehabil. 2021;40(5):588e594. https://doi.org/10.1016/j.hansur.2021.06.005

Yamamoto M, Tatebe M, Nakagawa Y, Kurimoto S, Iwatsuki K, Hirata H. Radial osteotomy for Keinbock's disease: clinical and radiological comparison between younger and older patients. J Hand Surg Asian Pac Vol. 2021;26(3):410e416. https://doi.org/10.1142/S2424835521500405

Barrera-Ochoa S, Campillo-Recio D, Mu~ noz-Perdomo T, Esteban-Feliu I, Mendez-Sanchez G, Mir-Bullo X. Dorsolateral biplane closing radial osteotomy and lunate fixation for stage IIIC Keinbock's disease: a new surgical approach. Tech Hand Up Extrem Surg. 2018;22(3):74e80. https://doi.org/10.1097/BTH.0000000000000197

Camus EJ, Van Overstraeten L, Schuind F. Lunate biomechanics: application to Keinbock's disease and its treatment. Hand Surg Rehabil. 2021;40(2):117e125. https://doi.org/10.1016/j.hansur.2020.10.017




DOI: https://doi.org/10.46903/gjms/22.02.1607

Refbacks

  • There are currently no refbacks.


Copyright (c) 2024. Asad Ullah Jan, Sajjad Ahmed, Sajjad Khan, Abdullah Khan, Jahandad Anwer, Sidra Tul Muntaha, Muhammad Shoaib Khan

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan

ISSN: 1819-7973, e-ISSN: 1997-2067

Website: https://www.gmcdikhan.edu.pk

Phone: +92-966-747373

Scimago Journal & Country Rank