Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Testa, Gianluca; Lucenti, Ludovico; D’Amato, Salvatore; Sorrentino, Marco; Cosentino, Pierluigi; Vescio, Andrea; Pavone, Vito

doi:10.3390/jcm11123402

Cited by 7 publications

(9 citation statements)

References 48 publications

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“…33 Although a comparison of several VBGs in the literature have demonstrated union rates from 86 to 94%, 34 other reviews of studies have cast doubt on clear superiority in union rates and functional outcomes of VBGs over NVBGs. [35][36][37][38] Volar flexion (humpback) deformity is usually associated with significant bone loss and malalignment leading to dorsal intercalated segment instability (DISI), which requires correction to decrease pain, increase wrist mobility, facilitate union, and arrest progression to arthritis. 39 Furthermore, the presence of DISI can pose a risk of failure to VBGs.…”

Section: Results Of Literature Review and Fracture Scenarios Acute No...mentioning

confidence: 99%

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Samade,

Awan

2024

J Wrist Surg

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Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV

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Section: Results Of Literature Review and Fracture Scenarios Acute No...mentioning

confidence: 99%

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Samade,

Awan

2024

J Wrist Surg

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“…Scaphoid fractures represent the most prevalent type of carpal fracture, accounting for 60% of all carpal bone fractures [26]. They mainly occur in young adults and constitute around 3% of all fractures [27].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Scaphoid Fractures: A Systematic Literature Review

D’Itri,

Gattuso,

Cobisi

et al. 2024

JPM

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Bilateral scaphoid fractures are rare lesions, warranting a review to synthesize current knowledge, identify gaps, and suggest research directions. Two authors, adhering to PRISMA guidelines, in January 2024 identified 16 case reports (1976–2023). Data extraction included demographics, injury mechanisms, associated injuries, fracture sites, treatments, and outcomes. Among 121 initial outcomes, 16 articles met the criteria, predominantly affecting young people (93.75% males, mean age 22 years). High-energy traumas (75%) often caused associated wrist injuries (68.75%). Most fractures required surgical intervention (68.75%), primarily headless compression screws. Bilateral scaphoid fractures, which are rare but associated with high-energy traumas, commonly involve wrist injuries. Surgical management is often necessary, yielding better outcomes with fewer complications. Further research is essential to understand the epidemiology, optimal management, and long-term results. Early diagnosis and appropriate treatment are crucial for preventing complications and ensuring favorable patient outcomes.

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“…Nonvascularized bone grafting procedure is widely used for scaphoid nonunion without ischemic necrosis (De Vitis et al, 2020; Dustmann et al, 2017; Russe, 1960; Zoubos et al, 2011). The common drawback of this technique is that it does not yield satisfactory results for patients with avascular proximal fracture segment, and it is also difficult to correct the humpback deformity because of the absorption of the bone graft (Merrell et al, 2002; Testa et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…for patients with avascular proximal fracture segment, and it is also difficult to correct the humpback deformity because of the absorption of the bone graft (Merrell et al, 2002;Testa et al, 2022).…”

Section: Case2mentioning

confidence: 99%

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Chen,

Wang,

Tang

2023

Microsurgery

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BackgroundFree vascularized bone grafting (FVBG) has become one of the essential methods for treating scaphoid nonunion complicated by avascular necrosis. However, commonly used bone graft, including the medial femoral condyle bone graft and iliac crest bone graft, still present challenges such as a high rate of donor site complications and variations of vascular pedicle. In this study, we have introduced a novel bone graft—the lateral humeral condyle bone graft with the posterior branch of the radial collateral artery (PBRCA) as the vascular pedicle—as an alternative option, with the aim of overcoming some of the limitations of previously described FVBG procedures.MethodsNine patients who had a nonunion of the scaphoid that had been present for an average of 16.8 months (range 9–35 months) were managed with use of a free vascularized bone graft obtained from the lateral humeral epicondylar region. Avascularity of the scaphoid, as assessed on preoperative magnetic resonance imaging and intraoperative bone marrow puncture test. Postoperatively, regular X‐ray and CT scans examinations were conducted to assess the progress of fracture healing. Active motion of the wrist, and grip strength recovery were measured periodically. Wrist pain was graded using the Visual Analogue Scale (VAS), while wrist joint functionality was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH) questionnaire and the Patient‐Rated Wrist Evaluation (PRWE) scale. The elbow functional outcome was evaluated by the Mayo Elbow Performance Score (MEPS).ResultsAll of nine lateral humeral epicondylar bone grafts were successfully harvested. The blood supply of the graft during surgery was excellent in six cases and good in three cases. The size of the bone grafts ranges from 1.0 cm × 0.5 cm × 0.5 cm to 2.0 cm × 1.0 cm × 0.5 cm. The average vascular pedicle length was 3.4 cm (range 2.0–6.0 cm). There were no early complications in either the donor or recipient areas after surgery. Union was successfully achieved in all nine patients, with an average time to union of 14.3 weeks (range 11–20 weeks) after surgery. The average follow‐up period was 31.2 months (range 26–40 months). At the final follow‐up, the average palmar flexion, dorsal extension, radial deviation, and ulnar deviation angles of the injured wrist joint were 56.1° (range 45°–70°), 56.1° (range 40°–80°), 10.6° (range 5°–20°), and 22.2° (range 15°–35°), respectively, which reached 79.0%, 82.1%, 59.4%, and 72.8% of the average activity of the contralateral normal side. The average grip strength of the injured side was 35.2 kg (range 22–51 kg), which was equivalent to 81.3% of the average grip strength of the contralateral side. The average VAS score for wrist joint pain was 1.0 point (range 0–2 points); the Quick‐DASH score was 9.2 points (range 6–18 points); and the PRWE score was 13.1 points (range 9–16 points), the Mayo Elbow Performance Index was 100 points (range 100–100 points). One patient reported a feeling of friction during movement but no pain. One patient reported numbness in the donor site. One patient complained of pain when applying force to the scar in the donor area. During the follow‐up period, these complications showed improvement without any treatment.ConclusionThe FVBG technique has been considered an effective method for treating scaphoid nonunion with avascular necrosis. Compared to traditional FVBG, the lateral humeral epicondylar bone graft exhibits a higher union rate, fewer complications, and easier accessibility, making it a favorable choice.

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Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Cited by 7 publications

References 48 publications

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Bilateral Scaphoid Fractures: A Systematic Literature Review

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

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