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J Wrist Surg 2017; 06(03): 251-257
DOI: 10.1055/s-0036-1597575
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Critical Appraisal of Vascularized Bone Grafting for Scaphoid Nonunion

Ram K. Alluri
1   Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
,
Christine Yin
2   Department of Plastic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
,
Matthew L. Iorio
3   Division of Hand and Upper Extremity Surgery, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Carl J. Shapiro Clinical Center, Boston, Massachusetts
,
Hyuma Leland
2   Department of Plastic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
,
Wendy J. Mack
4   Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
,
Ketan Patel
2   Department of Plastic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
› Author Affiliations
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Publication History

19 September 2016

03 November 2016

Publication Date:
08 December 2016 (online)

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Abstract

Background Vascularized bone grafting (VBG) has the potential to yield reliable results in scaphoid nonunion; however, results across studies have been highly variable. This study critically evaluates surgical techniques, fracture location, and patient selection in relation to radiographic, clinical, and patient-centered outcomes after VBG for scaphoid nonunion.

Methods We conducted a systematic review of the literature for the use of VBG in scaphoid nonunion. Physical examination, radiographic, and patient-centered outcomes were assessed. Four substratifications were performed: the location of scaphoid nonunion, pedicled versus free technique, Kirschner wire (K-wire) versus screw fixation, and VBG done as a primary versus revision procedure.

Results A total of 41 publications were included in final analysis. VBG had an 84.7% union rate at 13 weeks after surgery. On an average, 89% of patients returned to preinjury activity levels by 18 weeks after surgery and 91% of patients reported satisfaction with the procedure. Proximal pole nonunions demonstrated similar union rates but lower functionality scores compared with nonunions across all regions of the scaphoid. Pedicled techniques demonstrated slightly improved range of motion compared with free technique. K-wire versus screw fixation demonstrated significantly higher union rates and faster union times. There were no differences in outcomes for VBG done as a primary versus revision procedure.

Conclusion VBG serves as a viable option for the treatment of scaphoid nonunion, with consistent union rates in addition to significantly improved postoperative patient functionality. The fixation of these vascularized bone grafts with K-wires versus screw fixation may result in superior radiologic outcomes.

Level of Evidence Therapeutic, Level III, systematic review.

Keywords

bone graft - microvascular - nonunion - scaphoid - vascular

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