Scaphoid Chronic Non-Union: Vascularized Bone Grafting

2021 ◽  
pp. 171-178
Author(s):  
Patrick L. Reavey ◽  
Jacques Henri Hacquebord
Keyword(s):  
Bone Grafting ◽  
Non Union ◽  
Vascularized Bone

A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Syed Shumon ◽  
Moin Durrani ◽  
Karthikeyan P. Iyengar ◽  
William Y. C. Loh
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Carpal Bone ◽  
Non Union ◽  
Scaphoid Fractures ◽  
First Case ◽  
Vascularized Bone ◽  
Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

scholarly journals Vascularized bone grafts for post-traumatic defects in the upper extremity

2021 ◽  
Vol 48 (1) ◽  
pp. 84-90
Author(s):  
Giovanna Petrella ◽  
Daniele Tosi ◽  
Filippo Pantaleoni ◽  
Roberto Adani
Keyword(s):  
Upper Extremity ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Bone Grafts ◽  
Bone Defects ◽  
Tissue Loss ◽  
Surgical Reconstruction ◽  
Non Union ◽  
Post Traumatic ◽  
Vascularized Bone

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

Failure of Surgery for Scaphoid Non-Union is Associated with Smoking

2006 ◽  
Vol 31 (3) ◽  
pp. 252-255 ◽  
Author(s):  
C. P. LITTLE ◽  
B. J. BURSTON ◽  
J. HOPKINSON-WOOLLEY ◽  
P. BURGE
Keyword(s):  
Bone Grafting ◽  
Smoking Prevalence ◽  
Screw Fixation ◽  
Delayed Union ◽  
Proximal Pole ◽  
Non Union ◽  
Scaphoid Fractures ◽  
The Uk ◽  
Vascularized Bone

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3–10.1, p = 0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

scholarly journals Vascularized bone grafting for the treatment of scaphoid non-union: case report

2019 ◽  
Vol 54 (2) ◽  
pp. 375-378
Author(s):  
Florin GROSEANU ◽  
◽  
Stefan CUCULICI ◽  
Radu VISAN ◽  
Bogdan SOCEA ◽  
...  
Keyword(s):  
Case Report ◽  
Bone Grafting ◽  
Non Union ◽  
Vascularized Bone

scholarly journals Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

2016 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
Rajesh Govindasamy ◽  
Ramkumar Gnanasundaram ◽  
Saravanan Kasirajan ◽  
Fawas Thonikadavath ◽  
Jeff Walter Rajadurai
Keyword(s):  
Bone Grafting ◽  
Locking Compression Plate ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Non Union ◽  
Humeral Shaft Nonunion ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.</p><p class="abstract"><strong>Methods:</strong> Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22).  The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.</p><strong>Conclusions:</strong> LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

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