Ambulatory Free Medial Femoral Condyle and Trochlea Flaps for Management of Scaphoid Fractures and Nonunions

Fractures of the scaphoid are the most common carpal bone fracture and have high rates of nonunion. Management of nonunions is crucial to preventing the predictable pattern of arthritis seen with scaphoid nonunion advanced collapse (SNAC). The medial femoral condyle (MFC) and trochlea (MFT) flaps have become a popular option for the management of recalcitrant nonunions. We analyzed our experience with outpatient free vascuarlized MFC/MFT flaps for management of scaphoid fractures and nonunions.

A retrospective review of a 2-surgeon approach to outpatient MFC/MFT flap reconstruction of scaphoid nonunions without postoperative flap monitoring was performed. Baseline demographic details, injury history, preoperative and postoperative radiographic analysis, operative details, and postoperative union were collected. Patients were discharged either on the day of surgery or the follow morning.

Ten patients met inclusion criteria. Four patients had involvement of the proximal pole and received an MFT as opposed to an MFC. Eight patients were discharged on the day of surgery, and the remaining 2 were discharged on the first postoperative day. Nine patients (90%) showed postoperative union on imaging, with no residual dorsal intercalated segment instability deformity.

Vascularized bone grafting with a free MFC/MFT for management of recalcitrant scaphoid nonunion can be successfully and safely performed without postoperative monitoring in an outpatient surgery center setting. This series is the first to report on ambulatory free MFC/MFT flap reconstruction, and to our knowledge, it is the second in the literature to describe free vascularized tissue transfer of any kind performed with same-day discharge.

Level IV, Therapeutic.