scholarly journals Scaphoid Nonunion With Poor Prognostic Factors

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Tahseen Chaudhry ◽  
Lauren Uppal ◽  
Dominic Power ◽  
Michael Craigen ◽  
Simon Tan
Keyword(s):  
Prognostic Factors ◽  
Bone Graft ◽  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Vascularized Bone Graft ◽  
Union Rate ◽  
Poor Prognostic Factor ◽  
Low Incidence ◽  
Vascularized Bone

Background: To report on the results of free medial femoral condyle (MFC) vascularized bone graft for scaphoid nonunions with 1 or more poor prognostic factors. Methods: We have used the free MFC vascularized bone graft for scaphoid nonunions that have 1 or more factors associated with a poor prognosis. These were, a delay in presentation of over 5 years, a proximal pole nonunion, the presence of avascular necrosis (AVN), or previous nonunion surgery. We used this technique on 20 patients over a 4.5-year period. Results: Our overall union rate was 88.5% (17 of 19 patients), with 1 patient failing to attend for follow-up. Our mean union time was 7 months (2-18). All patients had at least 1 poor prognostic factor and over half had 2 or more. Of those with AVN with or without other factors, the union rate was 85% (11 of 13). There were 2 donor site complications that required a further procedure and 2 patients with residual wrist pain that required a scapho-trapezio-trapezoid joint fusion and a radial styloidectomy, respectively. Both nonunions were offered further surgery, and 1 elected to undergo successful revision surgery. Conclusions: Overall, this technique showed good results, in a subgroup of patients that typically have poorer outcomes, with a low incidence of donor site morbidity. Our union rate compares favorably with other techniques for this difficult subset of patients with 1 or more poor prognostic factors, although results are clearly not as good as those of studies using the MFC graft for all scaphoid nonunions. We continue to reserve this technique for nonunions with 1 or more poor prognostic factors, and we believe that this technique should at least be considered in these patients.

scholarly journals Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique

2015 ◽  
Vol 6 (02) ◽  
pp. 267-271 ◽  
Author(s):  
Ajit Kumar Sinha ◽  
Sumit Goyal
Keyword(s):  
Bone Graft ◽  
Perioperative Complications ◽  
Spinous Process ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Posterior Fusion ◽  
Vascularized Bone Graft ◽  
Novel Technique ◽  
Posterior Arthrodesis ◽  
Vascularized Bone

ABSTRACT Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. Summary of Background Data: C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. Materials and Methods: Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. Results: The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery—mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). Conclusion: Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.

Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Victoria Franziska Struckmann ◽  
Giuseppe Rusignuolo ◽  
Leila Harhaus ◽  
Ursula Trinler ◽  
Berthold Bickert ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Donor Site ◽  
Bone Grafts ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle ◽  
Vascularized Bone

Scaphoid Nonunion: Treatment with a Pedicled Vascularized Bone Graft Based on the 1,2 Intercompartmental Supraretinacular Branch of the Radial Artery

2002 ◽  
Vol 27 (5) ◽  
pp. 413-416 ◽  
Author(s):  
R. G. STRAW ◽  
T. R. C. DAVIS ◽  
J. J. DIAS
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Vascularized Bone Graft ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Union Rate ◽  
Fracture Nonunions ◽  
Vascularized Bone

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.

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

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.

Treatment of Spontaneous Osteonecrosis of the Tarsal Navicular With a Free Medial Femoral Condyle Vascularized Bone Graft

2013 ◽  
Vol 7 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Howard Levinson ◽  
Kyle J. Miller ◽  
Samuel B. Adams ◽  
Selene G. Parekh
Keyword(s):  
Bone Graft ◽  
Femoral Condyle ◽  
Treatment Options ◽  
Medial Femoral Condyle ◽  
Vascularized Bone Graft ◽  
Level Of Evidence ◽  
Excellent Outcome ◽  
Work Related ◽  
Spontaneous Osteonecrosis ◽  
Vascularized Bone

Adult-onset spontaneous osteonecrosis of the tarsal navicular joint, or Mueller–Weiss syndrome (MWS), is an uncommon debilitating disease characterized by a painful clinical course with progressive midfoot deformity. Treatment options include nonoperative management and/or operative intervention, including percutaneous decompression of the navicular bone, stabilization of existing structures, and cancellous bone grafting from the tibia or iliac crest. To our knowledge, there have been no reported cases of treatment of MWS with a vascularized bone graft. We report an unusual case of unilateral MWS in a 25-year-old male who failed nonoperative therapy and was successfully treated with a novel operative approach using debridement followed by a free medial femoral condyle vascularized bone graft. At 18-month follow-up, the patient demonstrated an excellent outcome with return to previous level of function, including work-related and recreational activities. Level of Evidence: Therapeutic, Level IV: Case study

Prefabricated Vascularized Bone Graft Using Autologous Tissue, Biomaterials, and Growth Factors: A New Technique for Bone Reconstruction

2005 ◽  
Vol 288-289 ◽  
pp. 51-54 ◽  
Author(s):  
A. Hokugo ◽  
K. Mushimoto ◽  
S. Morita ◽  
Yasuhiko Tabata
Keyword(s):  
Bone Graft ◽  
Bone Tissue ◽  
Blood Circulation ◽  
Donor Site ◽  
Vascularized Bone Graft ◽  
Time Intervals ◽  
Controlled System ◽  
Large Size ◽  
A New Technique ◽  
Vascularized Bone

Although clinically, grafting of vascularized autologous bone has been preferably performed, there are some disadvantages for this grafting therapy, such as the limited availability of donor site and the clinical difficulty to harvest the bone graft of desired shape and size. As one trial, we have designed a prefabricated vascularized bone graft by combining autologous vessels, particulate cancellous bone and marrow (PCBM), and β-tricalcium phosphate (β-TCP) with a biodegradable membrane. However, the volume of vascularized bone tissue newly formed was small and the density was low. In this study, the controlled system of basic fibroblast growth factor (bFGF) was combined with the conventional preparation method to improve the nature of vascularized bone graft. The femur vessels of rabbits were rolled with a membrane of L-lactide-ε-caploractone copolymer. Hydrogel microspheres of gelatin were prepared as the release carrier of bFGF. Autologous PCBM harvested from the beforehand tibia of rabbits was mixed with β-TCP granules with or without the microspheres incorporating bFGF and packed into the rolled membrane. When bone formation was assessed at different time intervals, additional mixing of bFGF significantly increased the volume of vascularized bone tissue compared to that without bFGF. It is concluded that combination of bFGF release system was a promising method to prefabricate the bone graft of large size with good blood circulation.

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