Treatment of scaphoid nonunion by free medial femoral condyle vascularized bone grafting

Abstract

The purpose of this study was to assess the results of the management of scaphoid non-unions using a vascularized medial femoral condyle graft. We operated on 16 patients with who presented with persistent non-union. Eleven cases in our series showed full consolidation and five cases showed persistent non-union. Methods: A retrospective study was designed in a series of 16 patients (16 scaphoids) with nonunion who were managed by vascularized medial femoral condyle grafts The mean follow up of the cases was 24 months ranged from 6 months to 30 months. Patient age and sex, duration of nonunion, number of previous surgical procedures, surgical technique, achievement of osseous union, preoperative and postoperative scapholunate angles, preoperative and postoperative range of motion, and pain relief were recorded. Results: Healing was confirmed in 11 of 16 reconstructed scaphoids. Mean patient age was 37.4 years (range, 27–49 y). The average number of previous surgical procedures was 1 (range, 0–3). All patients experienced some wrist pain improvement (10/16 complete relief). Wrist range of motion at follow-up averaged 48° extension (range, 25° to 86°) and 50° flexion (range, 25° to 68°). Scapholunate relationship remained unchanged with average scapholunate angles of 37.5° before surgery and 38° after surgery. Conclusion: Vascularized medial femoral condyle grafts provide a reliable means of achieving resolution of scaphoid nonunions. Early follow-up demonstrates a considerable rate of union with acceptable motion and pain relief.