Volume 1- Issue 7 : 2017 1830 Mini Review Open Access Kienbock Disease, a Tertiary Care Experience from the Developing World Yasir Mohib 1 *, Pervaiz Hashmi 2 , Muhammad Atif 3 , Haroon Ur Rashid 2 and Waseem Ahmed 1 1 Instructor orthopedics, AKUH, Pakistan 2 Associate Professor, AKUH, Pakistan 3 Resident orthopedics, AKUH, Pakistan Received: November 16, 2017; Published: December 01, 2017 *Corresponding author: Yasir Mohib, Instructor orthopedics AKUH, Karachi, Pakistan; Email: ISSN: 2574-1241 DOI: 10.26717/BJSTR.2017.01.000560 Yasir Mohib. Biomed J Sci & Tech Res Introduction Kienbock’s disease is a form of osteonecrosis characteristically affecting the lunate, first described in 1910 by Robert Kienbock who identified the changes in the proximal portion of the lunate and affecting the radiolunate articulation [2]. It is characterized by lunate sclerosis, cystic changes, fragmentation and articular surface collapse on plain radiograph [3,4]. It occurs most commonly in men aged 20 to 40 years of age. Its exact etiology is still under study but most hand surgeons believe to be a multi-factorial origin and some time establishing the diagnosis is a challenge especially in less experienced hands [5]. Litchman et al. [6] provided four progressive radiological stages of the disease which can be used access the progression of disease. Management of Kienbock’s disease is focused on alleviating pain and halt the worsening disease process [7]. Various standard modalities are used to treat this disease, including nonsurgical management, vascularised bone graft (VBG), joint levelling procedures, intercarpal arthrodesis, proximal row carpectomy and total wrist arthrodesis [8,9]. Gupta et al in 2014 presented their experience in 12 patients and found improvement in the functional outcome after treatment [3]. Our study aims to determine the functional and radiological outcome after surgery for Kienbock’s disease. Patients and Methods The retrospective review of patients managed operatively for Kienbocks disease from January 2005 to December 2015 at Aga Khan University Hospital Karachi. All adult patients with radiological evidence of Kienbocks disease were included. Kienbock disease was classified according to Lichtman and Ross Classification of Lunate osteonecrosis. Patients underwent various procedures including surgical decompression and vascular bone grafting, carpel fusion and iliac bone grafting, radial shortening, and external fixator. Cite this article: Yasir M, Pervaiz H, Muhammad A, Haroon U R, Waseem A. Kienbock Disease, a Tertiary Care Experience from the Developing World. Biomed J Sci & Tech Res 1(7)-2017. BJSTR. MS.ID.000560. DOI : 10.26717/BJSTR.2017.01.000560 Abstract Introduction: Kienbock’s disease is a form of osteonecrosis of lunate, first described in 1910 by Robert Kienbock. It occurs most commonly in men aged 20 to 40 years of age. Its exact etiology is still under study but most hand surgeons believe to be a multi-factorial origin and some time establishing the diagnosis is a challenge especially in unaccustomed hands. Management of Kienbock’s disease is focused on alleviating pain and halts the worsening disease process [1]. Our study aims to determine the functional and radiological outcome after surgery for Kienbock’s disease. Objective: To determine the functional and radiological outcome after surgery for Kienbock’s disease. Methods: The retrospective review of patients managed operatively for Kienbocks disease at Aga Khan University Hospital Karachi. Kienbock disease was classified according to Lichtman and Ross Classification. Patients underwent various procedures including surgical decompression and vascular bone grafting, etc. Radiological variables and outcomes were assessed. Results: Of the 7 patients, 3 (42.9%) were men and 4 (57.1%) women. The right side was involved in 5(71.4%) patients, and 2(28.6%) had a left sided Kienbock disease. Duration of symptoms ranges from 8 months to 84 months with mean 31.12 +/- 26.63. Post operative x-rays 6 months follow up which showed Ståhl index minimum 0.29 to maximum 0.45 with mean 0.36 (sd .055), Nattrass index ranges from 0.76 to 1.74 with mean 1.4 (sd 0.31) and Radioscaphoid angle varies from 46.3 to 60.6 with mean 51.7 (sd 5.4). Conclusion: We concluded that revascularization procedures are effective treatment in stage II and IIIa. Limitation was limited number of patients which encourage multi-centre trial to prove the efficacy of treatment.