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

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.

Vascularised bone graft is an effective technique for extracortical bone bridging to combat cemented megaprosthesis loosening at the bone–implant junction

Introduction: The bone–implant junction is a potential site for aseptic loosening. Extracortical bone bridging at the bone–implant junction is advocated to improve implant fixation by forming a biological seal. We propose a novel technique with vascularised bone graft (VBG) to form an extracortical bone bridge at the bone–implant junction to enhance implant stability. We compared the clinical and radiological outcomes for tumour megaprostheses performed (1) with and without bone graft and (2) with non-vascularised versus VBG technique. Methods: Forty-six tumour megaprosthesis procedures from 1 June 2007 to 31 October 2017 were identified from hospital records. Twenty-eight operations incorporated bone graft at the bone–implant junction, and 18 did not. Of these 28 bone graft procedures, 13 involved VBG, and 15 did not (non-VBG). The VBG technique involves resecting a short segment of healthy bone beyond the oncological margin with its preserved blood supply, splitting it, then securing it over the junction. Clinical outcomes assessed included loosening, fracture and recurrence. Extracortical bone growth at the bone–implant junction was quantified radiologically at intervals 0–24 months post-operatively. The mean follow-up was 4.27 years. Results: There were five incidences (27.8%) of loosening in the non-bone graft group compared to zero in the bone graft group ( p = 0.03). There was a higher radiological score of extracortical bone growth in the bone graft group compared to no bone graft at 3–24 months post-operatively ( p < 0.05). Within the bone graft group, the VBG group fared superior at 6 and 12 months post-operatively compared to non-VBG ( p < 0.05), as well as a lower rate of radiological junctional resorption ( p = 0.04). Conclusions: We recommend bone grafting for its merits of less implant loosening. We propose the VBG technique to combat early aseptic loosening in megaprosthesis replacement as there was a higher radiological score compared to non-VBG.

Mandibular reconstruction with autogenous non-vascularised bone graft

Background: Reconstruction of mandibular defects can be challenging because an acceptable aesthetic and functional outcome must be achieved simultaneously.Aim: To evaluate the pattern of mandibulectomy and reconstruction materials used in the reconstruction of mandibular defects.Materials and methods: This was a retrospective study of mandibulectomies with reconstruction in Sokoto, Nigeria between 2012 and 2016. Data such as demographics, type of tumour, type of resection and type of reconstruction materials used were extracted and stored.Results: Fifty-two cases of mandibulectomies were done comprising 24 males and 28 females (ratio 1:1.2). Age ranged 5-80 years with mean±SD (37.8±15). Most of the cases 30 (57.7%) were on the right. There are 35 (67.3%) benign and 17 (32.7%) malignant cases. Thirty (57.7%) lateral, 16 (30.8%) condylar, 1 (1.9%) central and 5 (9.6%) combined mandibular defects were seen. Reconstruction plate alone was used in 11 (21.2%) cases, reconstruction plate with rib and tibia grafts in 16 (30.8%) cases, reconstruction plate with Iliac crest and tibia grafts in 15 (28.8%) cases. Graft length ranged from 0-20cm. There was satisfactory outcome altogether in 32 (80.0%).Conclusion: This study has shown the types of mandibulectomies and reconstruction materials used in our centre.Keywords: Grafts, mandibular defects, reconstruction plate.

Free vascularized femoral condyle bone graft in treatment of tubular bone nonunions

Vascularised bone graft from femoral condyles - are relatively new method in treatment of bone nonunions, small bone defects and loss of articular cartilage. In this article experience of using of vascularized bone grafts from medial and lateral femoral condyles, operation technique and clinical cases with long-term results were described. In conclusion, authors generated basic indications for free vascularized bone grafts from femoral condyles.

Surgery tactic in humeral nonunion

Relevance. Humerus fractures comprise 5 to 8% of all. Nonunions are uncommon, although in cases of infection, poorly vascularized beds, and open, segmental, or severely comminuted fractures, secondary bony healing may still be compromised. In cases of decreased blood supply, the choice of a vascularised bone graft seems inevitable. Purpose of study: analysis of effectiveness and choosing indications for Vascularized bone grafts in humeral nonunion treatment. Patients and methods. 41 humeral nonunion surgery performed from 2010 to 2017 at a single institution: Vascularized fibular grafts were done in 38 and vascularized femoral condylar grafts used in 3 cases. ORIF performed in all cases. X-ray and CT-scan used for control in all patients. Results. After vascularized bone grafting union achieved in 36 cases (88%) in 4 to 6 month, with vascularized fibular grafts in 33 cases and with vascularized femoral condylar grafts in 3 cases. Conclusion. Any humeral nonunion case require individual treatment tactics. Using of vascularized bone grafts can be crucial in lack of local healing process and persistent nonunions of the humerus. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding

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

<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>