Vascularized Bone Grafts for Scaphoid Nonunions

Jones, David B.; Rhee, Peter C.; Shin, Alexander Y.

doi:10.1016/j.jhsa.2012.03.001

Cited by 30 publications

(15 citation statements)

References 34 publications

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“…The mean grip strength in this study increased 15 kg of force (95% CI, [11][12][13][14][15][16][17][18][19] at the last followup. This is consistent with comparison studies that demonstrated a recovery of grip strength from 79% to 104% of a normal wrist [14,26,36].…”

Section: Discussionmentioning

confidence: 80%

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

Kang

Chun

Koh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic management of scaphoid nonunions has been advanced as a less invasive technique that allows evaluation of associated intrinsic and extrinsic ligamentous injuries; however, few studies have documented the effectiveness of arthroscopic treatment of scaphoid nonunions and which intraarticular pathologies coexist with scaphoid nonunions. Questions/purposes (1) What are the outcomes of arthroscopic management of scaphoid nonunions as assessed by the proportion of patients achieving osseous union, visual analog scale (VAS) pain score, grip strength, range of motion, Mayo Wrist Score (MWS), and Disabilities of the Arm, Shoulder and Hand (DASH) score? (2) What complications are associated with arthroscopic scaphoid nonunion management? (3) What forms of intraarticular pathology are associated with scaphoid nonunions? Methods Between 2008 and 2012, we treated 80 patients surgically for scaphoid nonunions. Of those, 45 (56%) had arthroscopic management. During that time, our general indications for using an arthroscopic approach over an open approach were symptomatic scaphoid nonunions without necrosis of the proximal fragment, severe deformities, or arthritis. Of the patients treated arthroscopically, 33 (73%) were available for followup at least 2 years later. There were five distal third, 19 middle third, and nine proximal third fractures. The mean followup was 33 months (range, 24-60 months). Union was determined by CT taken at 8 to 10 weeks after operation with bridging trabecula at nonunion site. VAS pain scores, grip strength, active flexion-extension angle, MWS, and DASH scores were obtained preoperatively and at each followup visit. The coexisting intraarticular pathologies and complications were also recorded. Results Thirty-two (97%) scaphoid nonunions healed successfully. At the last followup, the mean VAS pain score decreased (preoperative: mean 4.

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Section: Discussionmentioning

confidence: 80%

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

Kang

Chun

Koh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The most commonly used vascularized bone grafts for the treatment of scaphoid nonunions include (1) 1,2 intracompartmental supraretinacular artery (ΙCSRA) bone grafts, (2) volar bone grafts from the distal radius, and (3) free pedicle bone grafts from the medial femoral condyle or the iliac crest. 9…”

Section: Introductionmentioning

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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“…Specifically, it has been used for the humerus and ulna [69][70][71][72] , as well as tibial and femoral defects [70,73,74] . Notably, this methodology has been well studied in the treatment of scaphoid AVN [66,68,75] , with studies reporting up to 100% of patients achieving union [76,77] and level III evidence that it is superior to 1,2-intercompartmental supraretinacular artery graft [68,77,78] . Finally, these studies have reported limited to no complications at both donor and recipient sites [73,77,79,80] .…”

Section: Bone Transport With Simultaneous Soft Tissue Reconstructionmentioning

confidence: 99%

Review of soft tissue coverage options in distraction osteogenesis of the extremity

Stoneburner¹,

Azadgoli²,

Howell³

et al. 2020

PAR

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Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps (12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.

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Vascularized Bone Grafts for Scaphoid Nonunions

Cited by 30 publications

References 34 publications

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

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

Review of soft tissue coverage options in distraction osteogenesis of the extremity

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