Vascularized Bone Grafting for Scaphoid Nonunion

Pedicled vascularized bone grafts (Zaidemberg’s technique) were used to treat 22 established scaphoid fracture nonunions, 16 of which were found to have avascular proximal poles at surgery. After a follow-up of 1–3 years, only six (27%) of the 22 fracture nonunions had united. Only two of the 16 nonunions with avascular proximal poles united, compared with four of the six nonunions with vascular proximal poles. We conclude that this technique of pedicled vascularized bone grafting may not improve the union rate for scaphoid fracture nonunions with avascular proximal pole fragments.

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A Critical Appraisal of Vascularized Bone Grafting for Scaphoid Nonunion

Journal of Wrist Surgery ◽

10.1055/s-0036-1597575 ◽

2016 ◽

Vol 06 (03) ◽

pp. 251-257 ◽

Cited By ~ 3

Author(s):

Ram Alluri ◽

Christine Yin ◽

Matthew Iorio ◽

Hyuma Leland ◽

Wendy Mack ◽

...

Keyword(s):

Systematic Review ◽

Bone Grafting ◽

Screw Fixation ◽

Kirschner Wire ◽

Surgical Techniques ◽

Scaphoid Nonunion ◽

Patient Centered ◽

Level Of Evidence ◽

Revision Procedure ◽

Vascularized Bone

Background Vascularized bone grafting (VBG) has the potential to yield reliable results in scaphoid nonunion; however, results across studies have been highly variable. This study critically evaluates surgical techniques, fracture location, and patient selection in relation to radiographic, clinical, and patient-centered outcomes after VBG for scaphoid nonunion. Methods We conducted a systematic review of the literature for the use of VBG in scaphoid nonunion. Physical examination, radiographic, and patient-centered outcomes were assessed. Four substratifications were performed: the location of scaphoid nonunion, pedicled versus free technique, Kirschner wire (K-wire) versus screw fixation, and VBG done as a primary versus revision procedure. Results A total of 41 publications were included in final analysis. VBG had an 84.7% union rate at 13 weeks after surgery. On an average, 89% of patients returned to preinjury activity levels by 18 weeks after surgery and 91% of patients reported satisfaction with the procedure. Proximal pole nonunions demonstrated similar union rates but lower functionality scores compared with nonunions across all regions of the scaphoid. Pedicled techniques demonstrated slightly improved range of motion compared with free technique. K-wire versus screw fixation demonstrated significantly higher union rates and faster union times. There were no differences in outcomes for VBG done as a primary versus revision procedure. Conclusion VBG serves as a viable option for the treatment of scaphoid nonunion, with consistent union rates in addition to significantly improved postoperative patient functionality. The fixation of these vascularized bone grafts with K-wires versus screw fixation may result in superior radiologic outcomes. Level of Evidence Therapeutic, Level III, systematic review.

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The Effect of Smoking on the Outcomes of Vascularized Bone Graft Surgery in Scaphoid Nonunion through Meta-analysis

Archives of Hand and Microsurgery ◽

10.12790/ahm.21.0106 ◽

2021 ◽

Author(s):

Young Woo Kwon ◽

Dong Hwan Kim

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Meta Analysis ◽

Bone Union ◽

Functional Score ◽

Vascularized Bone Graft ◽

Scaphoid Nonunion ◽

Union Rate ◽

Imaging Evaluation ◽

Vascularized Bone

Purpose: A vascularized bone graft is an option showing a good result to treat scaphoid nonunion. The analysis of the effects of smoking, which affects vascular and union of fracture, has been limited. We tried to analyze the effect of smoking on the outcomes of vascularized bone graft in scaphoid nonunion through meta-analysis Methods: Two researchers analyzed 923 papers searched for ‘scaphoid AND (vascularized OR vascularised OR flap OR pedicled)’ on MEDLINE and Embase (until November 2020). We selected 31 papers which contain that vascularized bone graft was performed for scaphoid nonunion, and the number or proportion of smokers could be confirmed. Through meta-regression analysis and subgroup analysis, whether the smoker’s rate had an effect on union rate, union period, functional score, imaging evaluation, range of motion, and complications rate was analyzedResults: A significant negative correlation between smoking and bone union rate was confirmed in pedicled vascularized bone grafting, and a significant positive correlation between smoking and bone union duration was confirmed in free vascularized bone grafting. Conclusion: It is necessary to have caution for nonunion when considering pedicled vascularized bone graft in smoking patients with scaphoid nonunion.

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Vascularized Bone Grafting in Scaphoid Nonunion

Hand ◽

10.1177/1558944716643080 ◽

2016 ◽

Vol 12 (2) ◽

pp. 127-134 ◽

Cited By ~ 3

Author(s):

Ram K. Alluri ◽

Christine Yin ◽

Matthew L. Iorio ◽

Hyuma Leland ◽

Jason Wong ◽

...

Keyword(s):

Patient Satisfaction ◽

Bone Grafting ◽

Pain Syndrome ◽

Activity Levels ◽

Scaphoid Nonunion ◽

Rates Of Return ◽

Multiple Metrics ◽

Previous Occupation ◽

Vascularized Bone

Background: The radiographic and clinical outcomes following vascularized bone grafting (VBG) for scaphoid nonunion have previously been reported in the literature; however, few studies report on patient-derived outcomes. The purpose of this study was to determine the effect of VBG for scaphoid nonunion on patient-derived outcomes. Methods: The MEDLINE and PubMed databases were queried for the use of VBG in scaphoid nonunion. We included studies that reported on patient-derived outcomes. We excluded studies with less than 10 patients or less than 6 months of follow-up. The primary outcomes assessed included functionality, percent and time to return to preinjury activity, postoperative pain, and patient satisfaction. Results: Twenty-six articles described the outcomes of 520 patients with an average of 19.3 patients per study. Functionality was most commonly assessed by the Mayo Modified Wrist Score and Disabilities of the Arm, Shoulder and Hand scores, which improved by 53.1% and 81.7% postoperatively, respectively. Within 16 weeks, 90.3% of patients returned to their previous occupation or sporting activity. Pain was most commonly reported using a 0 to 10 visual analog scale and improved 4-fold postoperatively. Complete satisfaction was reported by 92% of patients. The most common complications were superficial infections (1.56%), neuropathic pain (1.56%), and complex regional pain syndrome (1.25%). Conclusions: VBG for scaphoid nonunion results in the improvement of patient-derived outcomes, and high rates of return to preinjury activity levels and patient satisfaction. Multiple metrics of patient-derived outcomes were utilized by the studies in our review without a clear consensus as to which metric is most responsive and accurate.

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Vascularized Bone Grafting from the Distal Radius for Scaphoid Nonunion

Operative Techniques: hand and wrist surgery ◽

10.1016/b978-1-4160-3659-3.50025-0 ◽

2008 ◽

pp. 235-247

Author(s):

Hiroshi Yajima ◽

Kevin C. Chung

Keyword(s):

Distal Radius ◽

Bone Grafting ◽

Scaphoid Nonunion ◽

Grafting From ◽

Vascularized Bone

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MR angiogram confirms sustained blood flow in 1,2 ICSR artery of vascularized bone grafting in scaphoid nonunion treatment

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-018-2339-z ◽

2018 ◽

Vol 29 (2) ◽

pp. 343-348 ◽

Cited By ~ 2

Author(s):

Ioannis K. Antoniou ◽

Efstratios D. Athanaselis ◽

Christos Rountas ◽

Antonios Koutalos ◽

Zoe Dailiana ◽

...

Keyword(s):

Blood Flow ◽

Bone Grafting ◽

Scaphoid Nonunion ◽

Mr Angiogram ◽

Vascularized Bone

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How Long Should We Immobilize the Wrist after Vascularized Bone Grafting for the Treatment of Scaphoid Nonunion?

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s242483552050040x ◽

2020 ◽

Vol 25 (03) ◽

pp. 353-358

Author(s):

Takuya Tsumura ◽

Taiichi Matsumoto ◽

Mutsumi Matsushita ◽

Kousei Ono ◽

Katsuma Kishimoto ◽

...

Keyword(s):

Range Of Motion ◽

Bone Grafting ◽

Healing Process ◽

Scaphoid Nonunion ◽

Union Rate ◽

Surgery Patient ◽

Significant Difference ◽

The Difference ◽

Vascularized Bone

Background: Although vascularized bone grafting can effectively treat scaphoid nonunion, the optimal duration of the immobilization period after bone grafting is unclear. Therefore, we aimed to examine the difference in the union rate and range of motion between short and long immobilization periods and infer the optimal post-immobilization period after pedicled vascularized bone grafting for scaphoid nonunion treatment. Methods: A total of 23 wrists (21 men and 1 woman) with scaphoid nonunion treated using an intercompartmental supraretinacular artery pedicled vascularized bone graft were analyzed. We examined the difference in the union rate and range of motion between patients immobilized for less than 49 days (short immobilization group) and those immobilized for more than 49 days (long immobilization group). The range of motion of the wrist joint was measured before and after surgery. Patient outcomes were also assessed. Results: The overall union rate was 95.6%. A significant difference was found in postoperative extension and flexion between the two groups, but not in terms of the functional outcome. If the intraoperative fixation is solid, intraoperative proximal pole bleeding is confirmed, and the follow-up radiograph shows a normal healing process, we propose immobilization of the wrist for ≤ 7 weeks. Conclusions: The immobilization duration should depend on the solidity of intraoperative fixation and a satisfactory appearance on follow-up radiography: absence of a gap at the graft interface, surrounding lucency, or movement of the implant and displacement of the graft. If there are no signs of graft failure and fixation is solid, immobilization of the wrist for 7 weeks or less is recommended.

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