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

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

2018 ◽  
Vol 44 (6) ◽  
pp. 600-606 ◽  
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

Medial Femoral Condyle Flap for Persistent Alveolar Cleft Reconstruction

FACE ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 146-150
Author(s):  
Blaine T. Abraha ◽  
Kristopher D. Day ◽  
Pablo L. Padilla ◽  
Steven L. Henry ◽  
Patrick K. Kelley ◽  
...  
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Dental Restoration ◽  
Bone Stock ◽  
Vascularized Bone Graft ◽  
Alveolar Cleft ◽  
Vascularized Bone

An alveolar cleft (AC) is typically repaired using a non-vascularized bone graft from the iliac crest. Such alveolar bone grafts (ABGs) are reliable but not infallible. We present the case of an 18-year-old male with a persistent AC with the instability of the cleft-side medial incisor and canine, status post 4 failed ABGs. The medial femoral condyle (MFC) flap was chosen to provide vascularized and similarly contoured bone. The patient recovered well and now has adequate bone stock for dental restoration.

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.

Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft

2015 ◽  
Vol 41 (5) ◽  
pp. 492-500 ◽  
Author(s):  
D. O. Ferguson ◽  
V. Shanbhag ◽  
H. Hedley ◽  
I. Reichert ◽  
S. Lipscombe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Study Design ◽  
Scaphoid Fracture ◽  
Vascularized Bone Graft ◽  
Level Of Evidence ◽  
Data Set ◽  
Non Union ◽  
Quality And Outcomes ◽  
Vascularized Bone

This systematic review assesses the quality and outcomes of published articles concerning bone graft surgery for scaphoid fracture non-union. Searches of the CENTRAL, MEDLINE, EMBASE, CINAHL and AMED databases captured 2710 articles. Each article was screened and 144 met our inclusion criteria. Data regarding source, study design, population, intervention, comparator and outcomes were extracted. There were 5464 scaphoid non-union outcomes within the 144 studies. Mean reported union rates for vascularized and non-vascularized bone graft were 84% and 80%, respectively. Avascular necrosis was diagnosed in several ways and, when present, the vascularized bone graft union rate was 74% compared with 62% with non-vascularized bone graft. Reported union rates vary considerably. These differences may be due to patient factors, fracture factors, treatment factors or study design failures or bias. We recommend that future researchers take into account the deficiencies of previous studies and use the suggested minimum data set in future studies. Level of evidence: II

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

2014 ◽  
Vol 40 (8) ◽  
pp. 848-854 ◽  
Author(s):  
A. Elgammal ◽  
B. Lukas
Keyword(s):  
Bone Graft ◽  
Blood Supply ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Proximal Pole ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Non Union ◽  
Structural Support

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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