Scaphoid nonunion treated with vascularised bone graft from dorsal radius

Özalp, Taçkın; Öz, Çağlar; Kale, Gürler; Erkan, Serkan

doi:10.1016/j.injury.2015.05.032

Cited by 18 publications

(16 citation statements)

References 35 publications

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“…Nineteen articles approximately 1,2 ICSRA for scaphoid nonunion met inclusion criteria and were included in the study. 15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] In total there were 541 patients with scaphoid nonunion. Avascular necrosis was evident in 242 of them.…”

Section: 2 Intracompartmental Supraretinacular Artery Bone Graftmentioning

confidence: 99%

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The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Tsantes

Papadopoulos

Gelalis

et al. 2019

Journal of Hand and Microsurgery

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Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement (p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.

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Section: 2 Intracompartmental Supraretinacular Artery Bone Graftmentioning

confidence: 99%

“…In a recent study, the use of this graft resulted in consolidation of the graft in eight out of nine cases with scaphoid nonunion, with an average time to union 9.9 weeks. 25…”

Section: +5 Extracompartmental Artery Bone Graftmentioning

confidence: 99%

The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Tsantes

Papadopoulos

Gelalis

et al. 2019

Journal of Hand and Microsurgery

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“…VBG is a reasonable treatment option because it maintains cell viability and drives a bone healing process similar to primary fracture healing [ 19 ]. Quicker stabilization and lesser immobilization period are other advantages of VBGs [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and functional outcomes of vascularized bone graft in the treatment of scaphoid non-union

Rahimnia

Mobasher-Jannat

2018

PLoS ONE

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IntroductionScaphoid non-union is a challenging and complex problem. Various methods have been proposed for the management of patients with scaphoid non-union and to reduce the risk of complications. In this study, our aim was to evaluate the clinical and functional outcomes of using a vascularized bone graft in the treatment of scaphoid non-union.MethodsPatients with scaphoid non-union who underwent 1,2 intercompartmental supraretinacular artery pedicled vascularized bone graft between January 2005 and January 2011 were enrolled. The parameters assessed included clinical and functional outcomes, radiological measures, and potential risk factors.ResultsForty-one patients were finally included. Thirty patients achieved union (73%) and 11 did not. Smoking was a significant risk factor for non-union after the surgery. In patients who achieved union, grip strength and radioulnar abduction were greater in comparison to that in patients who did not achieve union. Functional measures, including the Disabilities of Arm and Shoulder score and the Modified Mayo Wrist Score, improved in patients with scaphoid union. The scaphoid length also improved significantly postoperatively in these patients.ConclusionSurgical treatment of scaphoid non-union using vascularized bone graft led to a high union rate with good clinical and functional outcomes. Smoking is a risk factor for non-union, even with the use of a vascularized bone graft. Avascular necrosis was not associated with an increased risk for non-union.

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“…12,13 Factors that may influence union include smoking, delay in diagnosis, fracture displacement, fracture location, and associated ligamentous injury. 6,14,15 To date, achievement of healing remains suboptimal possibly due to residual instability. 16 Ideally, treatment should restore anatomy while improving the mechanics of the wrist.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The optimal treatment for scaphoid nonunion remains controversial with multiple studies evaluating different fixation techniques, screw type, bone graft, and surgical approach. [4][5][6] Since scaphoid nonunion can stem from vascular insufficiency or instability or both, surgery that addresses only one aspect, such as vascularized bone graft alone, may not address the underlying issue in some of the patients, accounting for the imperfect results reported in the literature. 7 We have been adding fixation with two Kirschner wires (KWs), as well as bone graft from the distal radius and an intramedullary screw in an attempt to enhance stability.…”

Section: Introductionmentioning

confidence: 99%