A Scaphoid Osteochondral Autograft for Reconstruction of the Lunate Fossa of the Distal Part of the Radius After a Complex Open Fracture: A Case Report.

Abstract

Complex fractures of the distal part of the radius in high-energy injuries or in elderly osteopenic patients often have extensive articular comminution. Often, these small fragments are not amenable to primary fixation. In high-energy open fractures, there may be substantial bone loss or missing osteochondral fragments. Moreover, concomitant carpal fractures are often present, as well as associated radiocarpal and carpal dislocations that offer additional challenges. Primary total wrist arthrodesis has been suggested for treatment of these difficult injuries1. Motion-preserving salvage procedures include total wrist arthroplasty, limited wrist fusion, and proximal row carpectomy (PRC). Total wrist arthroplasty is contraindicated in younger, more active patients because current implants require a low-demand lifestyle, and complication rates following surgery remain high2. Limited wrist fusion and PRC require an intact lunate fossa and thus may not be options in cases with substantial loss of articular surface. Autogenous osteochondral graft reconstruction of the articular surface of the distal part of the radius has been described in some small case series3-7. PRC involves resection of the scaphoid, lunate, and triquetrum, allowing the capitate to articulate with the lunate facet of the distal part of the radius. The scaphoid is therefore an ideal potential osteochondral donor graft for salvage of the lunate fossa when PRC is to be performed because it does not require a separate graft harvest procedure and does not cause additional donor-site morbidity. We report a case of a complex open radiocarpal fracture-dislocation with bone loss, demonstrating salvage of the lunate facet of the distal part of the radius with a scaphoid osteochondral autograft. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-five-year-old man was involved in a rollover motor vehicle collision and was transferred to …