Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Nonunion: A Systematic Review

Abstract

Background The free medial femoral condyle (MFC) bone flap is an attractive option for reconstruction of scaphoid nonunion utilizing vascularized bone to augment bony healing, especially in cases of failed prior treatment or osteonecrosis. This review aims to determine the role and reliability of the free MFC flap for treatment of scaphoid nonunion. Methods A search of electronic databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles examining free MFC bone flaps for treatment of scaphoid nonunion were included for analysis. Outcomes of interest included flap failure, postoperative union rate, time to union, carpal indices, functional outcomes, and complications. Results Twelve articles met the inclusion criteria. A total of 262 patients underwent free MFC flaps for treatment of scaphoid nonunion. The most common site of nonunion was the proximal pole of the scaphoid with 47% of patients receiving prior attempts at operative management. Overall bony union rate was 93.4% with a mean time to union of 15.6 weeks. There were no flap failures reported. Improvements in carpal indices including scapholunate (p < 0.0004), radiolunate (p < 0.004), lateral interscaphoid angles (p < 0.035), and revised carpal ratio height (p < 0.024) were seen postoperatively. Visual analog scale improved postoperatively from 6.5 to 2.3 (p < 0.015). Postoperative complications were observed in 69 cases (26.3%), with 27 patients (10.3%) requiring further operative intervention. However, no major donor or recipient site morbidity was appreciated. Conclusion MFC flaps provide a highly versatile and reliable option for reconstruction of scaphoid nonunion with excellent bony union rates and acceptable complication rates. The present literature suggests that MFC reconstruction of scaphoid nonunion restores radiocarpal anatomy and improves wrist function without causing significant donor or recipient site morbidity.

Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle

“…In this study, the corticoperiosteal flap has been demonstrated to be an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones, demonstrating a rate of bone healing of 94.92% (56/59 patients) with a mean radiographic bone healing time of 4.08 AE 1.29 months (range: 2-6 months) and low morbidity of the donor site, as widely described in the literature. [4][5][6][22][23][24][25] This study has some limitations: this is a retrospective study, the site of nonunion and the hardware used to do the fixation were not homogeneous, the surgical procedure was executed by two different surgeons in two different institutions, and a relatively small number of patients were enrolled for the study. To reduce the differences caused by the execution of the surgery by two different surgeons and in two different hospitals, the inclusion and exclusion criteria had been well established and shared by the two institutions participating in the study, providing the same approach to the pathology and the same surgical technique.…”

“…In this study, the corticoperiosteal flap has been demonstrated to be an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones, demonstrating a rate of bone healing of 94.92% (56/59 patients) with a mean radiographic bone healing time of 4.08 ± 1.29 months (range: 2–6 months) and low morbidity of the donor site, as widely described in the literature. 4 5 6 22 23 24 25…”

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

“…The most widely used FVBG is the medial femoral condyle graft (MFCG) based on the descending genicular artery, which was first reported by Doi et al (2000). A meta-analysis conducted in 2021 showed an average healing rate of 93.4% (Zhou et al, 2022). In addition to providing bone, the MFCG can also carry some cartilage for the reconstruction of scaphoid nonunion associated with proximal fractures and articular cartilage damage (Kälicke et al, 2008).…”

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

“…It offers the versatility of a small flap composed of a selection of periosteum, cortical, or cancellous bone while having potentially less donor site morbidity than traditional bone flaps. While there is mounting literature for the use of MFC flap in scaphoid nonunion, 17 its use for clavicle reconstruction is limited to case reports and small series. Clavicle nonunion is a different entity, with distinctions with regard to defects, soft tissue envelope, fixation techniques, and pathophysiological contributors to nonunion (e.g., infection, open injury, and radiotherapy), which are less often implicated in scaphoid nonunion.…”