Metaphyseal Core Research Articles

Guido Vernani, Averroism, and the Modernity of Dante’s Political Thought

The paper presents a reconstruction of the metaphysical core of Dante’s political thought as expressed in the Monarchy, following on the footsteps of Guido Vernani’s critique of Dante’s political ideas in his De reprobatione Monarchie composite a Dante (Bologna, 1327-1334). The paper focuses on the link between Dante’s alleged Averroism, an accusation formulated for the first time by the Dominican friar, but latter repeated by philosophical historiography, and the interpretation of the Monarchy as a sign of the beginning of modern philosophy.

Brain Patterns Shaping Embodied Activities of Their Bodily Limbs in Perception and Cognition

This essay aims to expose the metaphysical underpinnings of enactivism. While enactivism relies heavily on rejecting the traditional mind-body problem by excluding the familiar thought experiments that favor phenomenal dualism, the crucial point that is overlooked is instead the brain-body problem, specifically the crucial interaction between the brain and the bodily limbs in their embodied activities of perception and cognition. If enactivism is correct, differences in sensory experience necessarily entail differences in embodied activity—this is the metaphysical core of enactivism, which we think is entirely wrong. We will argue that a physical or biological body ("Körper") is configured or shaped into a perceptually living body ("Leib") by brain patterns and not by embodied activity or by the so-called sensorimotor contingencies. Undoubtedly, embodied actions influence sensory perception. However, since variations in embodied actions do not necessarily lead to variations in sensory experience, they are not metaphysically constitutive of these experiences (supervenience claim).

Coordination and obsolescence: a response on behalf of measurement realism

Measurement realism, the view that measurement targets quantitative attributes and that not all attributes are quantitative, has come under attack both from metrologists and philosophers. In this paper, I take a close look at two influential arguments against measurement realism: the argument from obsolescence and the argument from coordination. I concede that these arguments do challenge the epistemological position traditionally taken by measurement realists, but argue that the metaphysical core of measurement realism survives the challenge posed by these arguments. This metaphysical core is vital to maintaining a clear and ambitious standard for successful measurement.

O papel metafísico da historicidade

ABSTRACT I argue that the philosophy of historicity forms the metaphysical core of the historical way of thinking and, therefore, is relevant as a philosophy of history and historiography. From this perspective, the scope of the theorization of history should extend to the substantive metaphysical ground in which the modern idea of history was built to disclose the main temporal character of the historical phenomena to which historicity refers. Hence, since my goal here is the clarification of the meaningfulness of historicity, I examine the philosophical tradition that investigates the transient nature of reality-a key feature of the historicity of existence represented by G. W. F. Hegel, F. W. J. Schelling, and, above all, Martin Heidegger-since this tradition includes especially valuable ontological arguments for illuminating hidden presuppositions in the still-relevant understanding of history.

Онтологические горизонты этического, или Насколько глубок кризис современной этики

The article analyzes the anomalies observed in various spheres of modern culture, which are interpreted as “ethical failures” and the rejection of the fundamental principles of Western ethics: the principle of justice, fidelity to a given word, stri­ving for the common good, etc. Taking into account the totality of these failures in the sense of “horizontal” and “vertical” prevalence, it is suggested that there are deep ontological changes that entail transformations in the field of ethics. This the­sis is substantiated by an analysis of the structure of an ethical act, which allows us to single out levels of “public” and “ontological” expertise in it, and to see in the ethical act itself a way of establishing “transcendent” (unobservable, absent in the empirical dimension) objects and layers of social reality. Ethics in this case is (by itself) a sphere of ontological creation, a way of establishing legitimate con­figurations, boundaries and goals of social action, including the social identity and subjectivity of individuals. The need to preserve one’s own self and the ability to act meaningfully is considered in the article as the ultimate basis of human social activity and a source of “ethical energy”, which, without external coercion, deter­mines a person to ethical action. Existential involvement in ontological and ethical action determines a close connection between ethics and metaphysics, which is traced in the article on the basis of the most important philosophical concepts and ethnographic material. It is concluded that the cultural transformations analyzed in the article are associated with the use of constructivist impact on the ontological intuitions of Western culture, which, however, do not affect its metaphysical core, and thus only threaten the peripheral layers of Western ontology.

Метафизика языковых категорий в «лингвистическом кантианстве» и аналитической философии

This paper considers the Kantian philosophical tradition in western language philosophy of the XXth century, describes the ways of its influence and argues the existence of the “Kantian language philosophy tradition” as a continuous stage to be a certain evolutionary line in the history of philosophy. By now one ignores the influence of Kantian philosophy upon “those not pee linguistic turn” and does not esteem I. Kant as a philosopher of language, nor counts his influence in this sphere. The mode of this influence is uncertain and represents various views from synthesis to direct evolution. To discover this issue the author of this paper tries to find a metaphysic core element in language ontology, inherited by the analytic philosophers from I. Kant’s writings; conducts a comparative research of the aforementioned authors’ papers, extracts derived from I. Kant core metaphysical aspect in language ontology and a textological analysis, historical reconstruction. The researchers ignore historical and ontological links between language philosophy, Kantian and the analytical tradition due to a philological development of academic linguistics in the late XIXth – XXth centuries. Following the Kantian tradition in philosophy theories of the analytic philosophers (particularly W. Qwine and P. Strawson) contain the metaphysical core in language ontology, primarily in its syncretic essence of logical, semantic and utterly linguistic categories (i. e. the scheme of concepts, sense, universals, etc.). Syncretism of logical and linguistic essence in terms is also typical for the Kantian philosophy and characterizes the Kantian philosophy to be a source for the linguistic one, and a fully expressed the “Kantian language philosophy tradition”.

Metafísica da informação em um quadro referencial tridimensional

O objetivo deste estudo é expandir um dos assuntos que desenvolvi em minha pesquisa doutoral e apontar desenvolvimentos que ampliem o valor filosófico do tópico. A tarefa consiste em pavimentar o terreno para a construção de uma teoria metafísica tridimensional, centrada no conceito de informação. A primeira dimensão desta teoria é uma epistemologia informacional baseada nos levels of abstraction de Floridi. A segunda dimensão (semântico-pragmática) é baseada na filosofia da linguagem de Brandom e a terceira dimensão é baseada na ontologia de processo de Seibt. O resultado é um quadro referencial teórico metafísico versátil e dinâmico, que procura manter a eficiência do modelo metafísico clássico de propriedade-ente-substância, dotado de um núcleo metafísico da ontologia de processo. A tarefa de exposição desta teoria Floridi-Brandom-Seibt se divide em quatro etapas. Na primeira, darei uma definição geral de informação. Na segunda, definirei informação pragmática a partir do arcabouço conceitual elaborado por Robert Brandom. Estas duas etapas resultam de uma pesquisa parcialmente elaborada em minha tese. As duas etapas seguintes são um conjunto de reflexões que, até o momento, considero relevantes e profícuas possibilidades de desenvolvimento. A terceira etapa da exposição segue Luciano Floridi e propõe o deslocamento do conceito de informação como um produto de ações, desenvolvido na etapa anterior, para o papel de categoria central que constituirá a composição e compreensão do próprio mundo povoado por ações, entidades, eventos e processos. A quarta e última etapa desta reflexão procura vislumbrar o deus ex maquina da visão informacional de Floridi, revelando uma ontologia de processos como substrato último, de onde deve emergir o conceito de informação como tentativa de discretizar o continuum dos processos que perfaz a realidade.

Still a Misty Mountain: Assessing Parfit’s Non-Realist Cognitivism

This paper takes stock of Parfit’s latest defence of his meta-ethical view, non-realist cognitivism. In the third volume of On What Matters, Parfit gives his account a new—as I am going to show: conceptual—spin. Also, quite surprisingly, he takes back much of his earlier criticism of rival theories and claims instead that he and his opponents, Allan Gibbard and Peter Railton, are climbing the same meta-ethical mountain on different sides. Mainly focusing on the new spin in Volume III, I argue for the following four claims. Firstly, non-realist cognitivism can easily be accepted by all those believing in the irreducibility of normative concepts (not: facts). Secondly, Parfit succeeds in avoiding Mackie-style queerness objections. However, thirdly, once we fully grasp the conceptual rather than metaphysical core of non-realist cognitivism, it becomes clear that the view, if successful, would accomplish much less than Parfit’s talk about irreducible, non-natural normative facts may have previously suggested. Finally, I argue that the conceptual spin generates a problem regarding one of the crucial pillars of non-realist cognitivism, namely the status of normative facts as objective or mind-independent. It remains entirely unclear how the view could account for this status. All in all, non-realist cognitivism doesn’t clear up the mists covering the heights of the meta-ethical mountain. It is still a long climb to the summit, and in order to reach it, we have to answer many questions Parfit doesn’t address.

Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis.

Background: Metaphyseal core decompression of the distal radius (MCD) is clinically effective in early lunate necrosis without changing individual wrist mechanics. Its concept is based on the induction of physiologic mechanisms known as physiologic fracture healing response. However, this biological concept does not yet have its place in the historically developed mechanical concepts about Kienböck's disease and requires more detailed clarifications to understand when a change of individual wrist mechanics might be unnecessary. Methods: Thirteen consecutive cases, Lichtman stage I (n = 1) or II (n = 12), confirmed by conventional MRI, were treated by MCD. Time off work, changes in magnetic resonance imaging of the lunate, as well as clinical outcome using modified Mayo wrist score were evaluated at final follow-up. Results: Return to work was at six (1-10) weeks after surgery. MRI controls at short-term generally demonstrated stop of progression and signs of bone healing. Independently from ulna variance complete signal normalization was observed in six and a distinct, yet incomplete decrease of lunate bone marrow edema and zones of fat necrosis was confirmed in further six cases after a mean of 21 (13-51) weeks. One patient had radiographic controls only, stating normal healing at 56 months. After a mean follow-up of 37 (12-70) months the clinical outcomes were excellent in eleven and good in two cases (mean 95% in modified Mayo wrist score). Conclusions: In stage I and II lunate necrosis MCD stops disease progression, it improves clinical symptoms and induces normalization of lunate bone signal alterations in MRI. Findings suggest that stage I and II lunate necrosis can be effectively treated without alterations of individual wrist mechanics. Future studies are necessary to readjust common concepts regarding Kienböck's disease, especially focusing on conservative therapy.

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis.

Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis. [Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis

Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado.Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH.Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8.Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. ABSTRACTObjective: To report the consolidation rate and the outcomes of a series of 22 patientswith proximal pole scaphoid nonunion treated with a metaphyseal core decompressionand an anterograde self-compressing screw.Methods: We present a prospective series of patients with proximal pole scaphoidnonunion and confirmation of intraoperative bleeding in both fragments. Patientspresenting with displacement, degenerative changes, proximal pole fragmentation,cavitation at the fracture site, reduced bone length, and necrosis, as well as those withcarpal instability, were excluded. X-rays and computed tomography scans wereperformed to assess consolidation; range of motion and grip strength were recorded, andpatients completed a visual analogue scale for pain at rest, pain during activity, andsubjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder andHand) questionnaire.Results: Eighteen patients were included. Union was observed in 17 patients. Theaverage follow-up time was 22 months, and the average final range of motion was asfollows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnardeviation, and 85% for grip strength. The average score on the visual analogue scalewas 0 for pain at rest, 2 for pain during activity, and 9 for function, while the averageDASH score was 8.Conclusions: Using this simple and reliable technique, we obtained a 95% union andvery good functional results. Metaphyseal core decompression with an antegrade screwis a valid and effective alternative for treatment of proximal pole scaphoid nonunion incarefully selected patients.

Descompresión ósea metafisaria del radio distal para estadios tempranos de la enfermedad de Kienböck. Seguimiento mínimo de 10 años. [Metaphyseal bone decompression of distal radius for early stages of Kienböck's disease. Minimum follow-up of 10 years.

IntroducciónEl objetivo de este trabajo es analizar los resultados clínicos y radiológicos a largo plazo de una serie de pacientes con enfermedad de Kienböck en estadios II y IIIA de la clasificación de Lichtman, tratados mediante descompresión metafisaria del radio distal. Materiales y MétodosEste estudio retrospectivo y descriptivo incluyó a 23 pacientes con enfermedad de Kienböck (estadios II y IIIA de Lichtman) tratados mediante descompresión metafisaria del radio distal con al menos 10 años de seguimiento. Al final del seguimiento, los pacientes fueron evaluados para el rango de movimiento de muñeca, fuerza de puño, escala de Mayo modificada y el dolor, según la escala visual analógica (EVA). Se valoró radiográficamente según la clasificación de Lichtman y el índice de altura carpiana (IAC).ResultadosEl seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II. Basado en la escala de Mayo, los resultados fueron excelentes en 9 pacientes, buenos en 11 pacientes, moderados en 2 y pobres en un paciente. La EVA preoperatoria fue 7 (rango 6-10) y fue 1,1 (rango 0-6) en el seguimiento final. El arco de flexión/extensión promedio fue del 78% y la fuerza de puño del 81%. Según la clasificación de Lichtman se produjo progresión en 4 pacientes mientras que los otros 19 pacientes permanecieron en la misma etapa que en el preoperatorio. ConclusiónLa descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck. AbstractIntroduction: The purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of Kienböck disease treated with radius core decompression.Methods: This retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression, and were controlled for at least 10 years. At the last follow-up, wrist range of motion and grip strength using the modified Mayo wrist score and pain using the visual analogue scale were evaluated. Patients were also radiographically evaluated with the Lichtman classification and the modified carpal height ratio.Results: The mean follow-up period was 14 years (range 10-9). Nine patients were women and fourteen were men. Fifteen cases belonged to IIIA stage and 8 to II stage. Based on the modified Mayo wrist score, results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. Preoperative pain score according to VAS was 7 (range 6-10) and 1.1 (range 0-6) at the final follow-up. Average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to Lichtman classification occurred in four wrists, while the remaining 19 patients remained without changes.Conclusion: Radius core decompression achieved long-term favorable results in the early stages of Kienböck disease.

Exosomes secreted by mice adipose-derived stem cells after low-level laser irradiation treatment reduce apoptosis of osteocyte induced by hypoxia.

Kienböck's disease is a commonly seen posttraumatic avascular necrosis characterized by avascular necrosis of the lunate bone of the wrist which involves the dominant hand. In our study, we aimed to present midterm outcomes of 12 cases treated with radial metaphyseal core decompression. In our clinic, 12 patients who applied to our outpatient clinic with intractable pain despite at least six weeks of conservative treatment were previously diagnosed and evaluated as Kienböck's disease between the years 2006 and 2014. Patients at early stage received radial metaphyseal core decompression. The patients were evaluated as postoperative grip strength, flexion-extension gap, ulnar-radial deviation gap, VAS, Quick DASH and MAYO wrist scoring and patient satisfaction. We determined that interventions performed for Kienböck's disease cannot halt radiological progression. We are of the opinion that radial metaphyseal core decompression, aiming at increasing blood perfusion, improve early diagnosis and treatment of Kienböck's disease, increasing the patient satisfaction.

Mid term results of radial metaphyseal core decompression on Kienböck's disease.

Kienböck's disease is a commonly seen posttraumatic avascular necrosis characterized by avascular necrosis of the lunate bone of the wrist which involves the dominant hand. In our study, we aimed to present midterm outcomes of 12 cases treated with radial metaphyseal core decompression. In our clinic, 12 patients who applied to our outpatient clinic with intractable pain despite at least six weeks of conservative treatment were previously diagnosed and evaluated as Kienböck's disease between the years 2006 and 2014. Patients at early stage received radial metaphyseal core decompression. The patients were evaluated as postoperative grip strength, flexion-extension gap, ulnar-radial deviation gap, VAS, Quick DASH and MAYO wrist scoring and patient satisfaction. We determined that interventions performed for Kienböck's disease cannot halt radiological progression. We are of the opinion that radial metaphyseal core decompression, aiming at increasing blood perfusion, improve early diagnosis and treatment of Kienböck's disease, increasing the patient satisfaction.

Long Term Outcomes of the Radius Core Decompression for the Early Stages of the Kienböck’s Disease

There is no financial information to disclose. This study was designed to analyze the long-term clinical and radiological outcomes of a series of patients with Kienböck’s disease stage II and IIIA treated with radius core decompression. This retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who received distal radius metaphyseal core decompression between 1998 and 2005 and were followed-up for at least 10 years. Patient with other stages (I, IIIB or IV) or skeletally immature were excluded. At the last follow-up, the patients were evaluated for comparative wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio (CHR). Complications were recorded. Statistical analysis was performed. The mean follow-up period was 14 years (range 10-19). Nine were females and fourteen males. Fifteen were stage IIIA and eight were stage II. Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 13 patients and poor in one patient who required a proximal row carpectomy as revision surgery. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up, showing a significant improvement (P > 0.05). Moreover, at the final follow-up, 18 of the 23 patients had VAS either 0 or 1. There were no statistical differences neither in VAS or modified Mayo score improvement between the stage II and IIIA. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. All patients, except one, returned to their original employment. Radiographic disease progression according to the Lichtman classification occurred from stage II to IIIA in two patients and from stage IIIA to IIIB in another two wrists; whilst the others 19 patients remained in the same stage as preoperatively. The average preoperative CHR in stage II was 1.52 (1.48-1.58) and in stage IIIA was 1.38 (range 1.5-1.28). The average posoperative CHR in stage II was 1.50 (1.40-1.58) and stage IIIA was 1.34 (range 1.42 -1.25), showing no statistical decreased in the lunate height (P < 0.05). There were no complications related to the core decompression. (Figs. 21-1, 21-2) •Radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage II and IIIA of Kienböck’s disease.Figure 21-2(A) Bone scan at 5-months post-operatively, showing increased signal in the carpus. (B) Posteroanterior radiographs 12 years after surgery. The patient has no pain and excellent clinical outcome, according to the modified Mayo score.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up

This study was designed to analyze the long-term clinical and radiological outcomes of a series of patients with Kienböck disease stage IIIA treated with radius core decompression. This retrospective study included 15 patients with Kienböck disease (Lichtman stage IIIA) who underwent distal radius metaphyseal core decompression between 1998 and 2005 and who were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analog scale pain score. We also compared the radiological changes between the preoperative and the final follow-up in their Lichtman classification and the modified carpal height ratio. The mean follow-up period was 13 years (range, 10-18 years). Based on the modified Mayo wrist score, clinical results were excellent in 6 patients, good in 8 patients, and poor in 1 patient who required a proximal row carpectomy as revision surgery. The mean preoperative pain according to the visual analog scale was 7 (range, 6-10) and was 1.2 (range, 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 77% and the grip strength was 80%. All patients, except 1, returned to their original employment. At the final follow-up, 3 patients had decreased modified carpal height ratio, 12 remained unchanged. Radiographic disease progression according to the Lichtman classification to stages IIIB to IV occurred in only 2 wrists. There were no complications related to the core decompression. In this limited series, the radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage IIIA of Kienböck disease. Therapeutic IV.

KEINBOCK’S DISEASE

Objectives: To evaluate the functional and radiological outcome of metaphysealcore decompression of distal radius for treating Keinbock’s disease. Study Design: Descriptivecase series. Place and Duration: Orthopaedic A Unit Lady Reading Hospital Peshawar andGhurki Trust Teaching Hospital, Lahore and District Headquater Hospital Temargarah LowerDir from January 2014 to June 2016. Material and Methods: Patients of all ages and bothgender with pain and restricted wrist motion and radiologically diagnosed Lichtman’s stageI, II and III (A) were included in the study. Metaphyseal core decompression of distal radiuswas performed in the included subjects and patients were followed fortnightly for two monthsand then monthly for at least one year. At each visit pain was assessed with Visual AnalogueScale (VAS), wrist flexion and extension measured with goniometer and Stahl index with x raywrist. 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 Ipatients were 2(18.1%), stage II were 6(54.5%) while stage III (A) patients were 3(27.2%).Postoperatively 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 andmost of stage III (A) patients (90.9%). Only one (9 %) patient of stage III (A) could not achieveadequate wrist mobility at last follow up. Pre and post op Stahl index remained the same for allstages. No complication was reported. Conclusion: Metaphyseal core decompression of distalradius results in excellent functional outcome in majority patients and should be the treatmentof choice for early Keinbock’s disease (stage I’II and III (A).

English

Objectives: To evaluate the functional and radiological outcome of metaphysealcore decompression of distal radius for treating Keinbock’s disease. Study Design: Descriptivecase series. Place and Duration: Orthopaedic A Unit Lady Reading Hospital Peshawar andGhurki Trust Teaching Hospital, Lahore and District Headquater Hospital Temargarah LowerDir from January 2014 to June 2016. Material and Methods: Patients of all ages and bothgender with pain and restricted wrist motion and radiologically diagnosed Lichtman’s stageI, II and III (A) were included in the study. Metaphyseal core decompression of distal radiuswas performed in the included subjects and patients were followed fortnightly for two monthsand then monthly for at least one year. At each visit pain was assessed with Visual AnalogueScale (VAS), wrist flexion and extension measured with goniometer and Stahl index with x raywrist. 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 Ipatients were 2(18.1%), stage II were 6(54.5%) while stage III (A) patients were 3(27.2%).Postoperatively 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 andmost of stage III (A) patients (90.9%). Only one (9 %) patient of stage III (A) could not achieveadequate wrist mobility at last follow up. Pre and post op Stahl index remained the same for allstages. No complication was reported. Conclusion: Metaphyseal core decompression of distalradius results in excellent functional outcome in majority patients and should be the treatmentof choice for early Keinbock’s disease (stage I’II and III (A).

Arthroscopic Treatment of Scaphoid Nonunion Without Bone Graft and Distal Radius Core Decompression

Introduction: The scaphoid bone is the most commonly broken carpal bone and an untoward characteristic of this bone is its unpredictable union. The management of scaphoid nonunion still remains controversial with a reported failure rate up to 40% and absence of a “gold standard” of treatment. Based on the new concepts of the potential osteogenic capacity of the nonunion cells with the ability to heal, the encouraging results generated by increasing vascularization within the metaphyseal radius, and ulna decompression used in the treatment of Kienböck disease as well as the advantages of minimal surgical trauma using percutaneous and arthroscopic techniques, we propose to treat scaphoid nonunions with (a) arthroscopic-assisted reduction and internal fixation (AASSIF) and adding (b) metaphyseal core decompression of the distal radius (MCDDR) in advanced stages, without bone graft. Material and Methods: We evaluated retrospectively 48 patients with scaphoid nonunions treated prospectively by (AASSIF) with (MCDDR) in 48 cases. The average age was 30.63 years. The right side was affected in 31 patients, and 79.7% corresponded to the dominant extremity. The mean time from injury to surgery was 22.93 months. The nonunions were grouped according to the Slade-Dodds classification. Results: Scaphoid union was obtained in 44 patients, 4 patients failed to obtain healing. One patient decided to not be operated again, because of the lack of symptoms. Three required a new surgical procedure 9 months later. In 2 patients, the failures were by improper placement of the screw, although these patients had no symptoms. In cystic and/or magnitude bone nonunion defects with large zones of necrosis, defect filling was observed, even in those cases in which the loss of bone stock exceeded 10 mm. The biological effect of the metaphyseal decompression characterized by an increased hyperemia over the radial column was demonstrated with SPECT studies. The visual analogue scale showed an average of 1.04 (0-2) postoperative pain. The average postoperative range of function was 65.3° extension (range, 46° to 88°), 69.2° flexion (range, 55° to 88°), 10.7° radial deviation (range, 5° to 20°), and 26° ulnar deviation (range, 20° to 37°). The average Mayo score was 95 ± 6. Conclusion: We recommend arthroscopic-assisted internal fixation without bone grafting and core decompression of the distal radius for young or middle-aged nonsmoking patients with scaphoid nonunions including cystic and deformed types, typical of advanced stages. The method is not recommended for nonunions with significant sclerosis or in those with a very small proximal fragment in which solid screw fixation would be questionable.

Long-Term Outcomes of Distal Radius Metaphyseal Core Decompression for Kienböck Disease Stage IIIa

Background: Stage IIIa of the Lichtman classification is characterized by collapse of the lunate, with preservation of carpal height and intercarpal alignment. Although joint-leveling procedures and revascularization techniques have become the standard treatment during the past decade, these procedures have not been able to reverse Kienböck disease, and as many as 25% of patients have reported complications including infection, nonunion, and ulnar impingement. Core decompression techniques for the treatment of Kienböck disease stage I and II had demonstrated similar benefits as joint-leveling procedures (reduction in pain, improvement in functional activity, and improvement of motion) but a much simpler technique with almost no complications. The purpose of this study is to analyze the long-term clinical and radiological outcomes of a series of patients with Kienböck disease stage IIIa of the Lichtman classification treated with distal radius core decompression. Material and Methods: This retrospective study included 14 patients with Kienböck disease (Lichtman stage IIIa) who received distal radius metaphyseal core decompression between 1998 and 2005 and were followed-up for at least 10 years. Exclusion criteria were patients with previous surgery of the wrist, presence of osteoarthritis, and a history of major wrist trauma. At the last follow-up, the patients were evaluated for pain, comparative wrist range of motion and grip strength, and wrist functional status. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale (VAS) pain score. We also compared the radiological changes preoperatively and postoperatively in their Lichtman classification and the modified carpal height ratio. Results: The mean follow-up period was 13 years (range, 10-18). The mean age of the patients was 42 years old (range, 28-64); 9 were men. Based on the modified Mayo wrist Score, clinical results were excellent in 6 patients, good in 7 patients, and poor in 1 patient who require a proximal row carpectomy as revision surgery. The mean postoperative pain was VAS 1.5 (range, 0-7). Moreover, at the final follow-up, 10 of the 14 patients had VAS either 0 or 1. Compared with the opposite side, the average flexion/extension arc was 76% and the grip strength was 78%. All patients, except one, returned to their original employment. Radiographic disease progression according to the Lichtman classification to stage IIIb to IV occurred in one wrist, while the other patients remained in the same stage as preoperatively. The average preoperative modified carpal height ratio was 1.38 (range, 1.5-1.28) and the postoperative was 1.34 (range, 1.42-1.25). There were no complications related to the metaphyseal core decompression. Summary Points: (1) In this limited series, distal radius metaphyseal core decompression demonstrated favorable long-term results and is recommended as a surgical alternative for stage IIIa of the Kienböck disease. (2) This procedure may be a reasonable option for patients who prefer a simpler operation that may have a good result and allows to perform a more complex alternative if needed.