Freies gefäßgestieltes Knorpel-Knochen-Transplantat bei avaskulärer Nekrose des proximalen Kahnbeinpols

Abstract

The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a dreaded complication after conservative or operative treatment of a scaphoid bone fracture, which previously often led to partial or total stiffening operations on the wrist. Vascularized bone grafts can be used to increase the bone fusion rates in the presence of scaphoid pseudarthrosis with avascular necrosis. On a note of caution, it must be mentioned, though, that such a procedure in the presence of avascular necrosis of the proximal pole with destruction of cartilage can lead to premature radiocarpal arthritis, because a friction-free gliding in the area of the proximal scaphoid pole is no longer ensured as a result of the lacking cartilage cover.We confronted these problems in a 20-year-old male patient with avascular necrosis of the proximal scaphoid bone pole and destruction of the corresponding scaphoidal cartilage cover. We transplanted a free vascularized cartilage-bone graft from the medial femoral condyle, which was adapted in form and size to the proximal scaphoid bone pole with corresponding cartilage cover and was connected to the radial vascular bundle. This novel operation technique is described in this report and appears to be a promising way of avoiding premature radiocarpal arthritis when treating scaphoid bone pseudo-arthrosis with avascular necrosis in the presence of cartilage destruction.

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

“…A meta-analysis conducted in 2021 showed an average healing rate of 93.4% (Zhou et al, 2022). In addition to providing bone, the MFCG can also carry some cartilage for the reconstruction of scaphoid nonunion associated with proximal fractures and articular cartilage damage (Kälicke et al, 2008). However, short-term complications after surgery, such as donor site pain, hematoma, wound dehiscence, and long-term effects on knee joint function, have been reported as shortcomings of this graft (Windhofer et al, 2016;Zeman-Kuhnert et al, 2020).…”

“…Because it is unable to carry out cartilage reconstruction for the radioscaphoid joint. In such cases, the free vascularized cartilage-bone graft from the medial femoral condyle may be a better option (Kälicke et al, 2008). Additionally, the donor site may leave a linear scar, which may affect the aesthetic appearance of the arm.…”

Möglichkeiten der vaskularisierten Knochentransplantationen bei Defektpseudarthrosen an ausgewählten Beispielen der oberen Extremität

“…Im Jahr 2008 wurde von Kälicke und Bürger erstmals die Verwendung eines osteochondralen Femurspans zum Ersatz eines avaskulären proximalen Pols bei Kahnbeinpseudarthrose beschrieben [39]. Zur Rekonstruktion des proximalen Pols wird meist ein Knochenspan von ca.…”