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[Scaphoid pseudarthrosis : Complex reconstruction using vascularized bone grafts].

K H Kalb1, M Langer2, J Windolf3

  • 1Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.

Der Unfallchirurg
|February 7, 2019
PubMed
Summary
This summary is machine-generated.

Scaphoid reconstruction aims for union and deformity correction, often needing bone grafts. Vascularized grafts offer improved healing but their superiority over nonvascularized grafts remains debated.

Keywords:
Blood supplyFemoral condyleIliac crestRadiusReconstructive surgical procedures

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Area of Science:

  • Orthopedic surgery
  • Hand surgery
  • Bone reconstruction

Background:

  • Scaphoid pseudarthrosis requires reconstruction to correct deformities and achieve bony union.
  • Bone grafting is frequently necessary, with vascularized grafts developed to enhance healing and vascularization.

Purpose of the Study:

  • To present an experience-based treatment algorithm for scaphoid nonunion.
  • To critically evaluate the role and indications of vascularized bone grafts in scaphoid reconstruction.

Main Methods:

  • Review of existing literature on scaphoid reconstruction techniques, including pedicled and free vascularized bone grafts.
  • Comparison of fusion rates and outcomes between vascularized and nonvascularized bone grafts.
  • Discussion of osteochondral grafts for joint surface replacement.

Main Results:

  • Pedicled vascularized grafts from the distal radius show fusion rates of 27-100%.
  • Free microvascular grafts from iliac crest or femoral condyle achieve 60-100% fusion rates.
  • Nonvascularized grafts have also reported 100% fusion rates, making the superiority of vascularized grafts controversial.

Conclusions:

  • Vascularized bone grafts are indicated for secondary procedures after failed reconstruction or nonunion with avascular fragments.
  • Osteochondral grafts from the femoral condyle are unique for joint surface replacement.
  • An evidence-based guideline is lacking; this article offers an experience-based algorithm for scaphoid nonunion management.