| Title | Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. Surgical technique. | | Author(s) | Jones DB, Bürger H, Bishop AT, Shin AY | | Institution | Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA. | | Source | J Bone Joint Surg Am 2009 Oct 1.:169-83. | | MeSH | Adult
Bone Transplantation
Carpal Bones
Cohort Studies
Female
Femur Head
Follow-Up Studies
Fracture Healing
Fractures, Bone
Fractures, Ununited
Graft Rejection
Graft Survival
Humans
Injury Severity Score
Male
Middle Aged
Osteonecrosis
Probability
Radius
Recovery of Function
Retrospective Studies
Risk Assessment
Scaphoid Bone
Time Factors
Wrist Injuries
Young Adult
| | Abstract | BACKGROUND: Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft -- a distal radial pedicle graft and a free vascularized medial femoral condyle graft -- in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse.
METHODS: A retrospective review was conducted at two institutions to identify all patients with a scaphoid waist nonunion associated with an avascular proximal pole and carpal collapse. Between January 1994 and June 2006, twenty-two such nonunions were identified in twenty-two patients. Ten were treated with a distal radial pedicle vascularized graft and twelve, with a free vascularized medial femoral condyle graft. Patient demographics were similar between the groups, and the duration of follow-up averaged twelve months. Union was determined with use of plain radiographs and computed tomography or trispiral tomograms. In addition, carpal angles, time to union, union rates, and complications were recorded.
RESULTS: Four of the ten nonunions treated with the distal radial pedicle graft healed, at a median of nineteen weeks, and all twelve nonunions treated with the free medial femoral condyle graft healed, at a median of thirteen weeks. The rate of union was significantly higher (p = 0.005) and the median time to healing was significantly shorter (p < 0.001) for the nonunions treated with the medial femoral condyle graft.
CONCLUSIONS: A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
| | PubMed ID | 19805581 |
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