Vascularised bone graft for the treatment of non-union of the scaphoid

Kirkeby, Lone; Hansen, Torben Bæk

doi:10.1080/02844310600574072

Cited by 14 publications

(14 citation statements)

References 24 publications

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“…Several methods of transferring a VBG to the scaphoid have been reported in the literature. 14,15 These include the pronator quadratus pedicled bone graft, pedicled grafts based on the ulnar artery or the palmar carpal artery, the radial styloid fasciosteal graft, and pedicled grafts from the index finger metacarpal and the thumb metacarpal. Free VBGs from the iliac crest and the medial femoral supracondylar region have also been reported.…”

Section: Historical Perspectivementioning

confidence: 99%

2,3 Intercompartmental Supraretinacular Artery Pedicled Vascularized Bone Graft for Scaphoid Nonunions

Tan

Tu²

2013

Techniques in Hand &Amp; Upper Extremity Surgery

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Scaphoid nonunion is a complex problem that may continue to exist despite conventional methods of bone grafting and internal fixation. Vascularized bone grafting has been proposed as a treatment option for scaphoid nonunions with or without avascular necrosis of the proximal pole. Zaidemberg and colleagues first introduced the dorsal distal radius graft that has gained considerable popularity in the past 2 decades. Less commonly, the 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft has been used successfully with equally promising results. It has become the graft of our choice for the treatment of scaphoid nonunions as it has a longer pedicle and is able to provide a wider arc of rotation that allows easier reach of the volar carpus. The use of rigid internal fixation with screws also permitted early wrist range of motion and shorter periods of immobilization. In this article, we describe our surgical technique of harvesting the 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft. The anatomy, indications, contraindications, and complications of treatment are also detailed.

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Section: Historical Perspectivementioning

confidence: 99%

2,3 Intercompartmental Supraretinacular Artery Pedicled Vascularized Bone Graft for Scaphoid Nonunions

Tan

Tu²

2013

Techniques in Hand &Amp; Upper Extremity Surgery

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“…Several methods of transferring a vascularized bone graft to the scaphoid have been reported in the literature. 35,36 These include the pronator quadratus pedicled bone graft, pedicled grafts based on the ulnar artery or the palmar carpal artery, the radial styloid fasciosteal graft, and pedicled grafts from the index finger metacarpal and the thumb metacarpal. Free vascularized bone grafts from the iliac crest and the medial femoral supracondylar region have also been reported.…”

Section: Scaphoid Nonunionsmentioning

confidence: 99%

“…35,36 This raises the important question of whether or not improvement of the vascularity of the proximal pole would increase rates of union in cases with AVN. Recently, a meta-analysis found that vascularized bone grafting achieved an 88% union rate compared with a 47% union rate with screw and intercalated wedge fixation in scaphoid nonunions with AVN.…”

Section: Scaphoid Nonunionsmentioning

confidence: 99%

Treatment of Scaphoid Fractures and Nonunions

Kawamura

Chung

2008

The Journal of Hand Surgery

257

192

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Scaphoid fractures are common, but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Improvements in the diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole, and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions.

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“…1). One group contains all the VBFs that are retrieved from the dorsal radius, 9,[13][14][15] based on the 2,3 ICSRA (2,3-intercompartmental, supraretinacular art. ), the four ECA (fourth extensor compartment art.)…”

Section: Methodsmentioning

confidence: 99%

Comparative meta-analysis on the various vascularized bone flaps used for the treatment of scaphoid nonunion

et al. 2017

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We did a meta-analysis of the literature in order to clarify which of the vascularized bone flaps (VBF) used for scaphoid non-union treatment has the best outcome with regard to various parameters. We analyzed 54 articles that present nine different types of VBF. The analysis concerned demographical patient information, radiographic parameters, fracture classification, including the presence or non-presence of avascular necrosis of the scaphoid proximal pole (PP AVN), parameters that have to do with the surgery itself and the postoperative protocol, the healing of the nonunion and functional scores. The meta-analysis showed best healing potential for the femoral graft despite the complexity of the operation. On the other hand, the most commonly used 1,2-ICSRA flap makes the procedure more reproducible but showed worse results. The femoral flap was also among the most successful flaps when used for patients with PP AVN. The consolidation rate, in general, was not affected by the time elapsed between the fracture and the operation but by smoking and the presence of PP AVN. The meta-analysis could not reach many significant statistical conclusions because of either the small number of patients in some flap groups or the heterogeneity and lack of documentation in most of the articles. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1076-1085, 2017.

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Vascularised bone graft for the treatment of non-union of the scaphoid

Cited by 14 publications

References 24 publications

2,3 Intercompartmental Supraretinacular Artery Pedicled Vascularized Bone Graft for Scaphoid Nonunions

2,3 Intercompartmental Supraretinacular Artery Pedicled Vascularized Bone Graft for Scaphoid Nonunions

Treatment of Scaphoid Fractures and Nonunions

Comparative meta-analysis on the various vascularized bone flaps used for the treatment of scaphoid nonunion

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