Bone Grafting for Scaphoid Nonunions: Is Free Vascularized Bone Grafting Superior for Scaphoid Nonunion?

Aibinder, William R.; Wagner, Eric R.; Bishop, Allen T.; Shin, Alexander Y.

doi:10.1177/1558944717736397

Cited by 38 publications

(44 citation statements)

References 27 publications

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“…Our porcine model closely approximates clinical scenarios, making it ideal for testing of such methodologies as a bridge to clinical practice. Delivery of blood flow by implantation of an AV‐bundle or other vascularized tissue has proven beneficial in treating both avascular necrosis and non‐union of small carpal bones clinically . Structural allograft healing is accelerated in long bone segmental defects when combined with a vascularized fibular autograft, due to similar mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive‐Structural Allografts in a Porcine Tibia Model

Visser

Rezaie

Friedrich

et al. 2019

Journal Orthopaedic Research

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Cryopreserved bone allografts (CBA) used to reconstruct segmental bone defects provide immediate structural stability, but are vulnerable to infection, non-union and late stress fracture as the majority of the allograft remains largely avascular. We sought to improve the bone vascularity and bone formation of CBAs by surgical angiogenesis with an implanted arteriovenous (AV) bundle, using a porcine tibial defect model. Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen (SLA) mismatched Yucatan minipigs to reconstruct a 3.5 cm segmental tibial defect. A cranial tibial AV-bundle was placed within its intramedullary canal to induce angiogenesis. The AV bundle was patent in eight pigs and ligated in a control group of eight pigs. At 20 weeks neo-angiogenesis was evaluated by microangiography. Bone formation was measured by quantitative histomorphometry and micro-computed tomography. Seven of eight AV-bundles in the revascularized group were patent. One had thrombosed due to allograft displacement. Total vascular volume was higher in the revascularized allografts compared to the ligated group (p = 0.015). Revascularized allografts had increased levels of bone formation on the allograft endosteal surface compared to the ligated control group (p = 0.05). Surgical angiogenesis of porcine tibial CBAs by intramedullary implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation on allograft endosteal surfaces.

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Section: Discussionmentioning

confidence: 99%

Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive‐Structural Allografts in a Porcine Tibia Model

Visser

Rezaie

Friedrich

et al. 2019

Journal Orthopaedic Research

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“…In total there were 143 patients with scaphoid nonunion. 44,51,[54][55][56][57][58] In the cases included in these studies, the nonunion was too proximal to the bone so that an intercalary bone graft between the proximal and distal bone fragments could not be placed in most cases. Avascular necrosis was evident in 130 of them.…”

Section: Medial Femoral Condyle Free Graftsmentioning

confidence: 99%

“…59 In another comparative study between the medial femoral grafts and 1,2 ICSRA bone grafts for the treatment of scaphoid nonunions, the results were also superior for the free grafts with 79% union rate for the 1,2 ICSRA bone grafts and 89% for the medial femoral grafts. 55 The results of the osteochondral grafts from the medial femoral condyle have also been published. Bürger et al have published two studies regarding the use of these grafts in patients with proximal pole scaphoid nonunions and with Kienböck's disease.…”

Section: Medial Femoral Condyle Free Graftsmentioning

confidence: 99%

The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Tsantes

Papadopoulos

Gelalis

et al. 2019

Journal of Hand and Microsurgery

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Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement (p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.

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“…Spearman's correlation coefficients were calculated between the postoperative VAS score and the 2-year value for each measure. Results: The outcomes were similar in the CS and RB groups (Table 77- 1). Greater postoperative pain was related to a smaller radioulnar deviation arc and greater preoperative VAS and DASH scores (Table 77-2).…”

mentioning

confidence: 85%

“…In the BR group (n ¼ 20), the ulnar TFCC was reattached to the ulnar fovea using a 2-0 polyester thread passed through a bone tunnel created through the distal ulna. 1 Arcs of wrist extensionflexion, radioulnar deviation, supination-pronation, grip strength, instability of the DRUJ, and DASH and VAS scores were assessed before and 24 months after surgery. Instability of the DRUJ was assessed by applying manual force to the ulnar head in the supinated and pronated positions.…”

mentioning

confidence: 99%

Capsular Suture Versus Ulnar Fovea Bony Reattachment of the Triangular Fibrous Cartilage Complex in the Treatment of Distal Radioulnar Joint Instability: Preoperative Factors Relating to Postoperative Wrist Pain

Kakinoki¹,

Ikeguchi²,

Ohta³

et al. 2018

The Journal of Hand Surgery

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Bone Grafting for Scaphoid Nonunions: Is Free Vascularized Bone Grafting Superior for Scaphoid Nonunion?

Cited by 38 publications

References 27 publications

Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive‐Structural Allografts in a Porcine Tibia Model

Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive‐Structural Allografts in a Porcine Tibia Model

The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Capsular Suture Versus Ulnar Fovea Bony Reattachment of the Triangular Fibrous Cartilage Complex in the Treatment of Distal Radioulnar Joint Instability: Preoperative Factors Relating to Postoperative Wrist Pain

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