Proximal scaphoid rib graft arthroplasty

Abstract

We prospectively reviewed 14 patients with deficiency of the proximal pole of the scaphoid who were treated by rib osteochondral replacement arthroplasty. Improvement in wrist function occurred in all except one patient with enhanced grip strength, less pain and maintenance of wrist movement. In 13 patients wrist function was rated as good or excellent according to the modified wrist function score of Green and O'Brien. The mean pre-operative score of 54 (35 to 80) rose to 79 (50 to 90) at review at a mean of 64 months (27 to 103). Carpal alignment did not deteriorate in any patient and there were no cases of nonunion or significant complications. This procedure can restore the mechanical integrity of the proximal pole of the scaphoid satisfactorily and maintain wrist movement while avoiding the potential complications of alternative replacement arthroplasty techniques and problems associated with vascularised grafts and salvage techniques.

Costo-osteochondral graft (rib graft) reconstruction of the irreparable proximal scaphoid

“…Our results are comparable with the previously published results from Sandow (1998) and Veitch et al. (2007) in regard to range of motion, grip strength, union rates and maintenance of carpal alignment.…”

“…Data on outcomes of proximal scaphoid pole reconstruction with this technique are promising but limited. The article by Sandow (1998) with 22 patients was followed by another series with 14 patients (Veitch et al., 2007); 6 years later three cases with a follow-up of more than 2 years were reported by Yao et al. (2013).…”

Conservative treatment of scaphoid nonunion in children and adolescents

“…12 Furthermore, various surgical techniques with or without bone graftingand many types of osteosynthesis have been proposed. 4,[7][8][9][16][17][18] Although opinion supports the conservative management of paediatric scaphoid nonunion with prolonged immobilisation, 2,4,19 only a few cases have been reported. Fewer than 20 children with conservative treatment have been reported in the English literature.…”

The use of osteochondral flaps in the treatment of carpal disorders

“…The authors have been conducting research to answer these questions using an animal model (Higgins et al, 2017). Comparing for differences in morphology and histology in vascularized and nonvascularized osteochondral grafts months after implantation may give us insight into the importance of subchondral vascular perfusion for cartilage survival.…”