Reconstruction of Scaphoid Non-Union and Total Scaphoid Avascular Necrosis in a Pediatric Patient: A Case Report

Abstract

Background The medial femoral condyle vascularized bone graft has grown in popularity for treating recalcitrant fracture non-unions and has become particularly useful in treating scaphoid non-union with avascular necrosis of the proximal pole. The medial femoral condyle is an excellent source of dense, well-vascularized bone and results in minimal donor site morbidity. Methods We describe an unusual case of chronic scaphoid non-union and total scaphoid avascular necrosis in a skeletally immature patient. Scaphoid reconstruction was performed with a vascularized medial femoral condyle graft, with successful graft incorporation, and restoration of pain-free wrist motion. Conclusions Technical considerations for harvest of the medial femoral condyle bone graft in the skeletally immature patient are discussed.

Use of a Free Vascularized Medial Femoral Condyle Flap for Revision Surgery in a Pediatric Patient with Congenital Pseudarthrosis of the Clavicle

“…MFC flaps are rarely used in children, and it is difficult to determine the available size of grafts in children due to differences in femoral length [ 27 ]. We believe that it is important to determine the size of the graft from each femur length, considering that 29% of the distal joint surface can be used.…”

Avascular necrosis and fracture of the scaphoid in a child followed by non-union

“…After treatment by immobilization, one child had painless limitation of dorsiflexion 1.5 years later (Iqbal et al, 2007). The other skeletally immature patient had a chronic scaphoid non-union with total AVN (Ben-Amotz et al, 2015). A free vascularized medial femoral condylar graft was carried out at age 17, 6 years after the original injury, with good results.…”