Treatment of Scaphoid Nonunions with a Vascularized Bone Graft Based on the First Dorsal Metacarpal Artery (original) (raw)
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The Role of Vascularized Bone Grafting in Scaphoid Nonunion
Hand Clinics, 2019
Diagnosis of avascular necrosis should involve intraoperative evaluation of scaphoid vascularity following tourniquet deflation. In the setting of avascular necrosis, vascularized bone graft should be used to restore blood flow and promote osseous healing. The appropriate vascularized bone graft to be used for scaphoid reconstruction is determined by the presence of a preoperative scaphoid flexion (humpback) deformity or carpal collapse.
Journal of Wrist Surgery, 2021
Background A malreduction or missed scaphoid fracture may lead to nonunion or avascular necrosis (AVN). The aim of this study was to analyze the radiological and clinical outcome of patients with scaphoid nonunion (SN), who were treated with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft (1,2-ICSRA-VBG) fixed with K-wires or screws between 2014 and 2018. Methods Radiological assessment included posteroanterior, lateral, oblique, and angled posteroanterior projection. The wrist active joint range of motion was assessed with a universal goniometer, and grip and pinch strength with a dynamometer. The disabilities of the arm, shoulder and hand (DASH) questionnaire was used to evaluate functionality. Statistical analysis was performed using SPSS software (v16.0). Results A total of 68 patients (65 male) with a mean age 29.7 ± 8.5 years were evaluated in the study, and union was achieved in 55 (81%). A total of 45 (66%) patients had scaphoid waist fracture...
The fate of failed bone graft surgery for scaphoid nonunions
The Journal of hand surgery, 1989
Twenty patients with scaphoid nonunions had bone grafting procedures that failed to achieve union. Nineteen had persistent wrist pain. Electrical stimulation after bone grafting proved useless in obtaining union in five patients. Sixteen patients had additional surgery. Ten had repeat bone grafting. Six scaphoids united after a second grafting and one united after a third graft. However, at follow-up only three of these seven patients had no pain in their wrists. The rate of union was not affected by fracture location, the presence of proximal pole avascular necrosis, or instability. The three patients with nonunion after two bone grafts remain symptomatic. Six patients had salvage procedures; silicone replacement arthroplasty (3), wrist fusion (1), proximal pole excision (1), intercarpal fusion (1). Four were asymptomatic after one of these procedures and two (silicone arthroplasty and intercarpal fusion) became asymptomatic after wrist fusions. Five fractures, believed to be unite...
Vascularized bone graft from the palmar carpal artery for treatment of scaphoid nonunion
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1998
We report the use of a bone graft harvested from the palmar and ulnar aspect of the distal radius and vascularized by the palmar carpal artery for the treatment of scaphoid nonunion in 17 patients, ten of whom had already had unsuccessful surgery. Union was obtained in all cases at an average of 60 days (range, 45-90 days). The average follow-up was 16 months (range, 12-36 months). There were no failures.
Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review
Journal of Clinical Medicine
Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts. Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either ...
International Orthopaedics, 2010
We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p =0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.
Scaphoid nonunion: Treatment by open reduction, bone graft, and staple fixation
The Journal of Hand Surgery, 1995
Thirty-eight scaphoid nonunions were treated by iliac crest bone grafting and staple fixation. A distractor was inserted through an anterior incision and the scaphoid was distracted to restore its original length. The nonunion was then grafted and held with a staple. Consolidation was achieved in 36 cases despite 6 cases of partial avascular necrosis. Pain at the graft site, which was usually transient, was the only complication. Wrist extension was significantly improved. The main indication for iEhis procedure is pseudarthrosis of the middle third of the scaphoid.
Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion
International Orthopaedics, 2020
Introduction Fractures of the scaphoid account for 60-70% of all wrist bone fractures. The results of treatment in terms of bone healing vary depending on the type and location of the fracture, the time elapsed since the injury, the type of surgical treatment. Nonunion occurs in 5-15% of the cases on average. The purpose of this paper is to compare the surgical techniques and results of treating scaphoid nonunion (SNU) with osteoplastic xenografts of bovine origin or a vascularized autograft of the distal part of the dorsal radius. Methods We compare two groups of patients with symptomatic SNU, treated surgically with either a vascularized graft (n = 15) or a xenograft of bovine origin (n = 15). In the presurgical stage, the demographic characteristics of the patients, the time elapsed between injury and surgery, and classification of the injury (Schonberg, Herbert-Fisher, and Geissler-Slade) were recorded. One year following surgery, bone healing, total duration of the treatment, complications, the Mayo wrist score, and answers to the DASH questionnaire were analyzed. Results No statistically significant differences between the two groups of patients were observed for bone healing (86.7% vs 80%) or functional results. A highly significant difference was observed with respect to duration of the surgical intervention in favor of xenografts. Conclusion The xenograft method is simple and relatively acceptable, providing good results in terms of healing and functionality.