Vascularized medial femoral condyle graft for management of scaphoid non-union

The purpose of this study was to assess the results of the management of difficult scaphoid non-unions using a vascularized medial femoral condyle graft. We operated on 30 patients with necrosis of the proximal pole or with severe humpback deformity or who presented with persistent non-union despite previous surgery. Twenty-four cases in our series showed full consolidation and six cases showed persistent non-union. The free vascularized medial femoral condyle bone graft can provide not only structural support, but also a consistent and good blood supply that results in excellent rates of union. Level of evidence: IV

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Primary medial femoral condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418789329 ◽

2018 ◽

Vol 44 (6) ◽

pp. 600-606 ◽

Cited By ~ 6

Author(s):

Kathleen M. Kollitz ◽

Nicholas Pulos ◽

Allen T. Bishop ◽

Alexander Y. Shin

Keyword(s):

Bone Graft ◽

Avascular Necrosis ◽

Femoral Condyle ◽

Primary Treatment ◽

Medial Femoral Condyle ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Carpal Collapse ◽

Time From Injury ◽

Vascularized Bone

This study aimed to determine the outcome of free vascularized medial femoral condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Thirty of 32 patients healed at a median of 12 weeks. There was significant improvement from preoperative to postoperative lateral intrascaphoid angle, scapholunate angle, and radiolunate angle. Two scaphoids failed to unite; one patient underwent scaphoidectomy and four-corner fusion 15 months postoperatively after suffering a subsequent injury. Another patient underwent 1,2-intercompartmental supraretinacular artery-based vascularized bone grafting at 4 months postoperatively and then scaphoid excision with four-corner fusion 4 years later. The free vascularized medial femoral condyle bone graft restores scaphoid vascularity and architecture while promoting union in a subset of scaphoid nonunions that has historically been a clinical challenge. Level of evidence: IV

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

Foot & Ankle Specialist ◽

10.1177/1938640013514270 ◽

2013 ◽

Vol 7 (4) ◽

pp. 332-337 ◽

Cited By ~ 8

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

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