Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

Marco Keller,Gernot Schmidle,Anizar Faizi Anoar,Rohit Arora,Tobias Kastenberger,Peter Kaiser,Markus Gabl

doi:10.1007/s00402-020-03386-7

Abstract

IntroductionThis study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction.Materials and methodsThirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically.ResultsThe overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22–5), DASH (59–19) and PRWE (62–30) score decreased significantly. The scapholunate (71°–65°) and radiolunate (28°–18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%).ConclusionsThe vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.

Highlights

This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction
Treatment of scaphoid non-union typically consists of surgical treatment using a bone graft for better healing potential
Accepted indications for a vascularized bone graft at the scaphoid are initially failed attempts of fracture fixation with established scaphoid non-union, non-unions that have not united after a nonvascularized bone grafting, not treated non-unions following overseen fractures and avascular bone necrosis (Morbus Preiser) [12, 39, 45, 46]

Summary

Introduction

This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction. Schmidle et al recently proposed a more elaborated treatment algorithm with the addition of trabecular structure, sclerosis and proximal fragment fragmentation in 2D-CT data and potential blood supply based on the location of the non-union in 3D-CT reconstructions. They found out that proximal fragments with preserved trabecular structure without fragmentation show a statistically significant higher bone healing capacity. The derived algorithm could facilitate decision-making, but has still to be proven viable in routine use [42]

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Conclusion