Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Nonunion: A Systematic Review

2021 ◽  
Author(s):  
Kiane J. Zhou ◽  
David J. Graham ◽  
David Stewart ◽  
Richard D. Lawson ◽  
Brahman S. Sivakumar
Keyword(s):  
Femoral Condyle ◽  
Operative Management ◽  
Medial Femoral Condyle ◽  
Bony Union ◽  
Complication Rates ◽  
Scaphoid Nonunion ◽  
Union Rate ◽  
Recipient Site ◽  
Major Donor ◽  
Meta Analyses

Abstract Background The free medial femoral condyle (MFC) bone flap is an attractive option for reconstruction of scaphoid nonunion utilizing vascularized bone to augment bony healing, especially in cases of failed prior treatment or osteonecrosis. This review aims to determine the role and reliability of the free MFC flap for treatment of scaphoid nonunion. Methods A search of electronic databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles examining free MFC bone flaps for treatment of scaphoid nonunion were included for analysis. Outcomes of interest included flap failure, postoperative union rate, time to union, carpal indices, functional outcomes, and complications. Results Twelve articles met the inclusion criteria. A total of 262 patients underwent free MFC flaps for treatment of scaphoid nonunion. The most common site of nonunion was the proximal pole of the scaphoid with 47% of patients receiving prior attempts at operative management. Overall bony union rate was 93.4% with a mean time to union of 15.6 weeks. There were no flap failures reported. Improvements in carpal indices including scapholunate (p < 0.0004), radiolunate (p < 0.004), lateral interscaphoid angles (p < 0.035), and revised carpal ratio height (p < 0.024) were seen postoperatively. Visual analog scale improved postoperatively from 6.5 to 2.3 (p < 0.015). Postoperative complications were observed in 69 cases (26.3%), with 27 patients (10.3%) requiring further operative intervention. However, no major donor or recipient site morbidity was appreciated. Conclusion MFC flaps provide a highly versatile and reliable option for reconstruction of scaphoid nonunion with excellent bony union rates and acceptable complication rates. The present literature suggests that MFC reconstruction of scaphoid nonunion restores radiocarpal anatomy and improves wrist function without causing significant donor or recipient site morbidity.

Free Vascularized Medial Femoral Condyle Bone Graft After Failed Scaphoid Nonunion Surgery

2018 ◽  
Vol 100 (16) ◽  
pp. 1379-1386 ◽  
Author(s):  
Nicholas Pulos ◽  
Kathleen M. Kollitz ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Bone Graft ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Scaphoid Nonunion

Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

2020 ◽  
Author(s):  
Matteo Guzzini ◽  
Leopoldo Arioli ◽  
Clelia Rugiero ◽  
Marco Rossini ◽  
Giuseppe Argento ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Healing ◽  
Soft Tissues ◽  
Femoral Condyle ◽  
Donor Site ◽  
Medial Femoral Condyle ◽  
Lower Limbs ◽  
Femoral Diaphysis ◽  
Recipient Site ◽  
Non Union

Abstract Backgrounds Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap. Materials and methods The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications. Results The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients. Conclusions Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.

Horizontal Instability of the Acromioclavicular Joint: A Systematic Review

2019 ◽  
Vol 48 (2) ◽  
pp. 504-510 ◽  
Author(s):  
Gianna M. Aliberti ◽  
Matthew J. Kraeutler ◽  
Jeffrey D. Trojan ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Operative Management ◽  
Complication Rates ◽  
Ac Joint ◽  
Horizontal Instability ◽  
Joint Injuries ◽  
Meta Analyses ◽  
Joint Separation ◽  
Ac Joint Injuries

Background: Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. Purpose: To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. Study Design: Systematic review. Methods: The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. Results: Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. Conclusion: No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.

scholarly journals The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

2018 ◽  
Vol 11 (01) ◽  
pp. 006-013 ◽  
Author(s):  
Andreas Tsantes ◽  
Dimitrios Papadopoulos ◽  
Ioannis Gelalis ◽  
Marios Vekris ◽  
Emilios Pakos ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Bone Grafts ◽  
Medial Femoral Condyle ◽  
Scaphoid Nonunion ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Artery Graft ◽  
Consolidation Rate ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Abstract Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement (p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.

Sign in / Sign up

Export Citation Format

Share Document