scholarly journals Avascular necrosis with non-union of the scaphoid managed with a dorsal pedicled vascularised bone graft of the distal radius – a case report

2021 ◽  
Vol 8 (10) ◽  
pp. 3189
Author(s):  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand P. Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Bone Remodelling ◽  
Bone Grafts ◽  
Vascular Supply ◽  
Favourable Outcome ◽  
Proximal Pole ◽  
Non Union ◽  
Hand Surgeon ◽  
Vascularised Bone Graft

Avascular necrosis (AVN) of the scaphoid is common following proximal pole fractures due to an arduous retrograde arterial vascular supply and it is a challenge to the hand surgeon. The treatment for scaphoid non-union with avascular necrosis is vascularized or non-vascularized bone grafts. Non vascularised bone grafts (NVBGs) can be categorized as autograft or allograft and cancellous or cortical bone grafts. Vascularised bone grafts promote biological healing and revascularizes ischaemic bone and they are free or pedicled grafts. Pedicled vascularised bone grafts maintain the vascular supply of the donor bone graft and this leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the non-vascularised graft with good clinical and radiological outcomes. In this paper, we have treated avascular necrosis of scaphoid with a pedicled vascularised bone graft based on the 1, 2 intercompartmental supraretinacular artery (1, 2-ICSRA) that resulted in a favourable outcome.

TECHNIQUES FOR VASCULARISED BONE GRAFTING IN SCAPHOID NONUNION

Hand Surgery ◽  
1999 ◽  
Vol 04 (01) ◽  
pp. 21-31 ◽  
Author(s):  
D. J. Wheen ◽  
M. Robinson ◽  
S. Prachaporn ◽  
S. Visvanathan
Keyword(s):  
Internal Fixation ◽  
Bone Graft ◽  
Avascular Necrosis ◽  
Bone Grafting ◽  
Bone Grafts ◽  
Significant Problem ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Scaphoid Fractures

Nonunion of the scaphoid remains a significant problem in the management of scaphoid fractures. Recurrent persistent nonunion following attempts at internal fixation, and nonunions with sclerosis or avascular necrosis of the proximal pole of the scaphoid are particularly challenging. However, the aims of restoration of scaphoid anatomy and the achievement of union of the scaphoid remain the foundation pillars of scaphoid treatment. In recent years, several techniques for using vascularised bone grafts in the treatment of these difficult problems have been described. This article will review the currently described treatments, provide an overview of our unit experience with these techniques, and also describe a technique for in situ vascularisation of a conventional bone graft.

scholarly journals Outcome of vascularised muscle pedicle bone graft for scaphoid non-union

2018 ◽  
Vol 4 (2) ◽  
pp. 203
Author(s):  
Rajat Charan ◽  
Pankaj Kumar Verma
Keyword(s):  
Bone Graft ◽  
Screw Fixation ◽  
Proximal Pole ◽  
Hardware Failure ◽  
Non Union ◽  
Herbert Screw ◽  
Vascularised Bone Graft ◽  
Full Correction ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The objective of the study was to assess the <span lang="EN-IN">outcome of vascularised muscle pedicle bone graft for scaphoid non-union.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">14 men and 6 women aged 18-45 (mean 25) years with non-union of scaphoid involving proximal pole (n=4), waist (n=14), distal pole (n=2) were randomized to undergo vascularised muscle pedicle bone graft with Herbert screw fixation. The mean duration of non-union was 10 months (range 4-14 months)</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The mean follow up duration was 24 months. 17 of 20 achieved union. 12 of 20 achieved correction of both scapholunate and radiolunate angle. 5 of 20 did not achieve full correction of sacpholunate and radiolunate angle. 3 of 20 did not achieve union. 2 of these 3 were associated with proximal pole absorption. There was no hardware failure or any iatrogenic fracture during pedicle dissection. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The use of vascularised bone graft has proved to be an effective method for treating scaphoid non-union, especially non-union with an avascular proximal pole and those that have failed to heal after previous procedure.</span></p>

Neglected Scaphocapitate Syndrome

2021 ◽  
Author(s):  
Assaf Kadar ◽  
Sorin D. Iordache
Keyword(s):  
Avascular Necrosis ◽  
Vascular Supply ◽  
Vascular Studies ◽  
Resonance Imaging ◽  
Proximal Pole ◽  
Imaging Studies ◽  
Anatomical Reduction ◽  
Rare Injury ◽  
To Receive

Abstract Background Scaphocapitate syndrome is a rare injury where the proximal pole of the capitate rotates 90 to 180 degrees. The proximal pole of the capitate, thought to receive its vascular supply retrograde, is rendered avascular in such cases. However, recent evidence of low rates of avascular necrosis in displaced capitate fractures, and new vascular studies of the capitate, challenge this paradigm. Case Description We report a case of a missed and neglected scaphocapitate syndrome with more than 30 years follow-up. While the patient experienced midcarpal arthritis, the injury had not resulted in capitate proximal pole avascular necrosis as per T1 magnetic resonance imaging studies. Literature Review Missed and chronic cases of scaphocapitate syndrome were reported previously. Successful outcomes were achieved with anatomical reduction in cases without midcarpal arthritis. Salvage procedures or arthroplasty procedures are recommended with the presence of midcarpal arthritis. However, there are no reports of a neglected case with more than 30 years follow-up with preserved vascularity of the proximal pole of the capitate. Clinical Relevance This case illustrates that vascularity of the proximal pole of the capitate can be preserved even in longstanding displaced fractures.

scholarly journals The use of pedicled vascularized bone grafts in the treatment of scaphoid nonunion: clinical results, graft options and indications

2020 ◽  
Vol 5 (1) ◽  
pp. 1-8
Author(s):  
Bedri Karaismailoglu ◽  
Mehmet Fatih Guven ◽  
Mert Erenler ◽  
Huseyin Botanlioglu
Keyword(s):  
Bone Mass ◽  
Bone Remodelling ◽  
Bone Grafts ◽  
Clinical Results ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Challenging Situation ◽  
Clinical And Radiological Results ◽  
Vascularized Bone

Scaphoid nonunion is a challenging situation for orthopaedic surgeons. Nonunion rate is especially high in proximal pole fractures of the scaphoid due to tenuous retrograde blood supply. The use of pedicled vascularized bone grafts for the treatment of scaphoid nonunion provides both good clinical and radiological outcomes. The preserved vascularity of the graft leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the conventional non-vascularized grafting. Pedicled vascularized bone grafts also allow the correction of the carpal alignment and humpback deformity of the scaphoid. Clinical and radiological results have been satisfactory and promising, making us anticipate that the role of vascularized bone grafting for the treatment of carpal diseases will increase. Cite this article: EFORT Open Rev 2020;5:1-8. DOI: 10.1302/2058-5241.5.190021

A Comparison of the Use of Distal Radius Vascularised Bone Graft and Non-Vascularised Iliac Crest Bone Graft in the Treatment of Non-Union of Scaphoid Fractures

2008 ◽  
Vol 33 (5) ◽  
pp. 636-640 ◽  
Author(s):  
J. BRAGA-SILVA ◽  
F. M. PERUCHI ◽  
G. M. MOSCHEN ◽  
D. GEHLEN ◽  
A. V. PADOIN
Keyword(s):  
Bone Graft ◽  
Distal Radius ◽  
Iliac Crest ◽  
Surgical Techniques ◽  
Functional Results ◽  
Iliac Crest Bone Graft ◽  
Radiographic Findings ◽  
Non Union ◽  
Vascularised Bone Graft ◽  
Mean Time

We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1–5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

Primary Vascularized Distal Radius Bone Graft for Nonunion of the Scaphoid

2000 ◽  
Vol 25 (3) ◽  
pp. 266-270 ◽  
Author(s):  
C. UERPAIROJKIT ◽  
S. LEECHAVENGVONGS ◽  
K. WITOONCHART
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Distal Radius ◽  
Pinch Strength ◽  
Type I ◽  
Vascularized Bone Graft ◽  
Proximal Pole ◽  
The Mean ◽  
Mean Time ◽  
Vascularized Bone

A vascularized bone graft from the dorsoradial aspect of the distal radius was used with internal fixation to treat nonunion of the scaphoid in ten patients who had not received any previous surgical treatment. Five cases were classified as Lichtman type I and five as type II. The average age was 30 years (range, 18–40 years). Associated avascular necrosis was observed in five cases. Post-operatively pain was relieved and union was achieved in all cases. The mean time to union was 6.5 weeks. Range of motion, grip strength and pinch strength were also restored satisfactorily. These results suggest that this vascularized bone graft should be used as the primary procedure in Lichtman type I and II of scaphoid nonunions, regardless of the presence of avascular necrosis of the proximal pole.

Bone Grafts for Scaphoid Nonunion: An Overview

Hand Surgery ◽  
2015 ◽  
Vol 20 (02) ◽  
pp. 222-227 ◽  
Author(s):  
Steven E.R. Hovius ◽  
Tim de Jong
Keyword(s):  
Surgical Treatment ◽  
Bone Graft ◽  
Bone Grafts ◽  
Good Position ◽  
Vascularized Bone Graft ◽  
Scaphoid Nonunion ◽  
Non Union ◽  
Non Surgical Treatment ◽  
Vascularized Bone

The scaphoid is the most common fractured bone in the wrist. Despite adequate non-surgical treatment, around 10% to 15% of these fractures will not heal. Untreated scaphoid non-union can cause a scaphoid non-union advance collapse (SNAC), this is a progressive deformity and can cause degenerative changes in the wrist. Surgery is focused on achieving consolidation, pain reduction and a good position of the scaphoid while preventing osteoarthritis in the long-term. Surgery consists of reduction and fixation of the scaphoid with a non-vascularized or vascularized bone graft. An overview of the most used vascularized and non-vascularized bone grafts and their indications are presented.

scholarly journals Proximal Scaphoid Pole Reconstruction Utilizing Ipsilateral Proximal Hamate Autograft

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 495-499 ◽  
Author(s):  
Bassem Elhassan ◽  
Mohamed Noureldin ◽  
Sanjeev Kakar
Keyword(s):  
Avascular Necrosis ◽  
Vascular Supply ◽  
Surgical Reconstruction ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Secondary Fragmentation ◽  
Scapholunate Instability ◽  
Scaphoid Reconstruction

Background: Fractures of the proximal pole of the scaphoid can be difficult to heal because of its limited vascular supply. Furthermore, nonunion with avascular necrosis and secondary fragmentation makes surgical reconstruction a challenging procedure. Method: We describe a technique and report the outcome of a proximal hamate autograft to treat a proximal pole scaphoid nonunion with avascular necrosis. Results: At 3.5 years post reconstruction, the patient remains asymptomatic with union of his scaphoid reconstruction without any evidence of scapholunate instability. Conclusion: Proximal hamate autograft is a useful technique for addressing proximal pole scaphoid nonunions with avascular necrosis.

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