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

Abstract

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.

The free vascularized lateral femoral trochlea osteochondral graft: a reliable alternative for Stage III Kienböck’s disease

“…We believe that compromised vascularization of the lunate is the most important pathogenetic factor in Kienbo ¨ck's disease. This is addressed by techniques using local or free vascularized corticocancellous bone grafts (Arora et al, 2008, Daecke et al, 2005a, 2005bMatsumoto et al, 2018;Moran et al, 2005;Nakagawa et al, 2016;Tsantes et al, 2019;von Maydell and Bru ¨ser, 2008;Ye et al, 2020). Vascularized bone grafts alone do not allow reconstruction of a joint surface, especially the radiolunate cartilage.…”

Pronator quadratus pedicled bone graft for scaphoid non-unions

“…The muscle is sutured across the wrist joint which may limit the wrist movement post operatively. 15 The understanding of scaphoid non-unions and proximal pole necrosis has undergone a change. Gras and Mathoulin used vascularised bone graft based on the volar carpal artery and suggested the use of vascularised bone graft even for simple scaphoid non-unions.…”

Skaphoidpseudarthrosen – wenn das Kahnbein nicht heilen will

“…interkompartimentellen Arterie [18], wobei eben diese anatomische Gegebenheit auch die Ausdehnung und Positionierung des Transplantates bestimmen. Alternativ favorisieren einige Autoren freie gefäßgestielte Knochenblöcke zur Rekonstruktion des Skaphoids [19] (▶ Abb. 7).…”