Rib osteochondral graft for scaphoid proximal pole reconstruction

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Irreparable proximal scaphoid pole fractures present treatment challenges due to fragment size and limited vascularity.
• Current salvage procedures like partial wrist fusion or proximal row carpectomy are suboptimal for young individuals.
• Limited case reports exist on utilizing rib osteochondral grafts for proximal scaphoid reconstruction.

Purpose of the Study:

• To evaluate the efficacy of rib osteochondral grafts in reconstructing the proximal scaphoid pole.
• To assess functional outcomes and radiographic changes following this reconstructive procedure.

Main Methods:

• Four patients with irreparable proximal scaphoid pole fractures underwent reconstruction using rib osteochondral grafts.
• Mean follow-up was 24 months, with patients averaging 30 years of age at surgery.
• Outcomes measured included wrist range of motion, grip strength, wrist function scores, and radiographic assessment for osteoarthritis and carpal height.

Main Results:

• No donor site complications were reported.
• Significant improvements were observed in wrist range of motion (82° to 95°), grip strength (22 kg to 33 kg), and wrist function scores (40 to 70).
• No radiographic progression of arthrosis was noted, and carpal height remained stable.

Conclusions:

• Rib osteochondral grafting is a viable option for proximal scaphoid reconstruction, addressing the articular surfaces of the radius, capitate, and lunate.
• This technique offers flexibility and ease of fabrication for reconstructing complex scaphoid defects.
• The procedure demonstrated positive functional outcomes and prevented arthritic progression in this small cohort.