Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Pseudarthrosis

Abstract

Objective/Hypothesis: Nonunions of scaphoid are routinely treated by reconstruction with interposition of cancellous bone grafts from the iliac crest or distal radius. In unfavorable situations as persistent pseudarthrosis following surgical reconstruction or avascular proximal pole, vascularized bone grafts are preferred. Free vascularized bone grafts from the medial femoral condyle were introduced as an additional tool for reconstruction and showed promising results. Material and Methods: In this study, 71 scaphoid nonunions or pseudarthrosis were followed after reconstruction with vascularized bone graft form the medial femur. In 15 cases, an osteocartilaginous graft was used to replace the proximal pole. After a minimum follow-up of 6 months (64 patients), following data were evaluated: consolidation, complications, donor site morbiditiy, pain in rest and stress, range of motion, grip strength, and Krimmer score. Results: Consolidation rate was 88%, in 19.6 % minor complications occurred. Range of motion did not change significantly, 89% grip strength of opposite site could be regained. Pain (VAS) in rest was reduced by 73%, in stress by 51%. Donor site morbiditiy is tolerable: 14.5% had mild symptoms after 3 months, reducing to less than 2% after 6 months. Krimmer Score resulted in very good and good results in 60% of the cases. Conclusion: Reconstruction of scaphoid pseudarthrosis with the free medial femoral condyle bone graft is an adequate technique to reach high consolidation rates in unfavorable situations. Postoperative function improves in terms of grip strength and pain reduction. Range of motion impairment usually persists. The surgical technique is challenging, but the quality of the bone graft is superior to the pediculated bone grafts of the distal radius. In addition, the distal femur offers the possibility of a osteocartilaginous graft to replace the complete proximal pole. Frequently, salvage surgery like 4 corner fusion can be avoided by this technique.