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Bürger, HK; Windhofer, C; Gaggl, AJ; Higgins, JP.
Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions.
J Hand Surg Am. 2013; 38(4): 690-700. Doi: 10.1016/j.jhsa.2013.01.036
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Führende Autor*innen der Med Uni Graz
Bürger Karl-Heinz

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Purpose The descending geniculate artery's branching pattern includes periosteal vessels supplying the cartilage-bearing trochlea of the medial patellofemoral joint. Previous cadaveric studies described anatomic similarities between the greater curvature of the proximal scaphoid and the convex surface of the medial femoral trochlea (MFT). We describe the technique and report our first 16 consecutive cases of vascularized osteocartilaginous arthroplasty for chronic scaphoid proximal pole nonunions using the MFT, with a minimum of 6 months of follow-up. Methods Chart reviews of 16 consecutive cases of osteocartilaginous MFT flap transfers for scaphoid reconstruction were performed at 2 institutions. Follow-up data were recorded at a minimum of 6 months, with an average of 14 months (range, 6-72 mo). 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 Computed tomography imaging confirmed healing in 15 of 16 reconstructed scaphoids. Mean patient age was 30 years (range, 18-47 y). The average number of previous surgical procedures was 1 (range, 0-3). All patients experienced some wrist pain improvement (12/16 complete relief, 4/16 incomplete relief). Wrist range of motion at follow-up averaged 46 degrees extension (range, 28 degrees to 80 degrees) and 44 degrees flexion (range, 10 degrees to 80 degrees), which was similar to preoperative measurements (average 46 degrees extension and 43 degrees flexion). Scapholunate relationship remained unchanged with average scapholunate angles of 52 degrees before surgery and 49 degrees after surgery. Conclusions Osteochondral vascularized MFT flaps provide a reliable means of achieving resolution of difficult proximal pole scaphoid nonunions. These flaps allow resection of the proximal portion of the unhealed scaphoid and reconstruction with an anatomically analogous convex segment of cartilage-bearing bone. This technique provides the advantages of vascularized bone and ease of fixation. Early follow-up demonstrates a high rate of union with acceptable motion and pain relief. Clinical relevance Early follow-up suggests that the vascularized MFT osteocartilaginous flap is a valuable tool for treating challenging proximal pole scaphoid nonunions. (J Hand Surg 2013;38A:690-700. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)
Find related publications in this database (using NLM MeSH Indexing)
Adolescent -
Adult -
Bone Transplantation - methods
Cartilage - surgery Cartilage - transplantation
Cohort Studies -
Female -
Femur - surgery
Follow-Up Studies -
Fracture Healing - physiology
Fractures, Ununited - radiography Fractures, Ununited - surgery
Graft Rejection -
Graft Survival -
Humans -
Male -
Middle Aged -
Pain Measurement -
Reconstructive Surgical Procedures - methods
Retrospective Studies -
Risk Assessment -
Scaphoid Bone - injuries Scaphoid Bone - radiography Scaphoid Bone - surgery
Surgical Flaps - blood supply
Tomography, X-Ray Computed - methods
Treatment Outcome -
Wound Healing - physiology
Young Adult -

Find related publications in this database (Keywords)
Medial femoral trochlea flap
medial femoral condyle
osteocartilaginous autograft
scaphoid nonunion
vascularized bone
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