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

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.

Lunate Revascularization With Temporary Internal Radiocarpal Spanning Fixation for Kienböck Disease

Background The goal in the treatment of stages II and III Kienböck disease is to restore lunate vascularity and halt the progression of avascular necrosis. Methods We report the outcomes for patients with stages II and III Kienböck disease treated with fourth extensor compartment artery vascularized bone grafting and temporary radiocarpal spanning internal fixation. Nine patients with a mean age of 28.8 years were included. Mean clinical and radiographic follow-up were 4.9 and 1.9 years, respectively. Results Six patients had no change in Lichtman stage, 2 patients regressed 1 stage, and 1 patient progressed 1 stage. Mean postoperative quick disabilities of the arm, shoulder, and hand (QuickDASH) was 17.4. Mean postoperative visual analogue pain scale (VAS) was 1.8. Patients under age 25 trended toward improved clinical outcomes compared with patients over age 25. Two patients, aged 33 and 65, underwent proximal row carpectomy at a mean 30.5 months postoperatively. Conclusions In conclusion, the use of local vascularized bone graft with temporary internal radiocarpal spanning fixation provides a treatment option with outcomes comparable to existing literature with benefits inherent to internal immobilization.