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J Wrist Surg 2013; 02(03): 234-238
DOI: 10.1055/s-0033-1351787
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rib Cartilage Graft for Posttraumatic or Degenerative Arthritis at Wrist Level: 10-Year Results

Laurent Obert
1   Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, Besançon, France
2   Intervention, Innovation, Imagery, Engineering in Health, Medical and Pharmacology Section, University of Franche-Comté, Besançon, France
3   Clinical Investigation Center in biotherapy, University Hospital of Besançon, Besançon, France
,
Daniel Lepage
1   Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, Besançon, France
2   Intervention, Innovation, Imagery, Engineering in Health, Medical and Pharmacology Section, University of Franche-Comté, Besançon, France
3   Clinical Investigation Center in biotherapy, University Hospital of Besançon, Besançon, France
,
Maxime Ferrier
1   Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, Besançon, France
2   Intervention, Innovation, Imagery, Engineering in Health, Medical and Pharmacology Section, University of Franche-Comté, Besançon, France
,
Yves Tropet
1   Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, Besançon, France
2   Intervention, Innovation, Imagery, Engineering in Health, Medical and Pharmacology Section, University of Franche-Comté, Besançon, France
3   Clinical Investigation Center in biotherapy, University Hospital of Besançon, Besançon, France
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Publication History

Publication Date:
05 September 2013 (online)

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Abstract

Background Posttraumatic arthritides of the radiocarpal joint, secondary to scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), or Kienböck disease or in cases of intraarticularmalunion of the distal radius, are classically solved by some type of arthrodesis procedure. Osteochondral grafting provides a possible motion-sparing option that can diminish pain in the active patient.

Description of Technique A chondrocostal graft harvested from the ninth rib was inserted and fixed with a plate in place of the articular defect in cases of a malunited intra-articular distal radius fracture (7 cases) or to replace the proximal pole of the scaphoid in cases of SNAC or SLAC (18 cases). In Kienböck disease, the graft was inserted as a free cartilage spacer (4 cases).

Results Harvesting the graft from the ninth rib had minimal morbidity without pleural injury in the reported series. Graft union was achieved in all cases of fixation. No graft resorption or necrosis were observed on X-ray and magnetic resonance imaging (MRI) evaluation at the longest follow-up of 10 years. Histological analysis performed at the time of plate removal showed the vitality of the graft. Two thirds of the patients had excellent or good results using the Green and O'Brien score.

Conclusions Reconstruction of a partially destroyed articular surface using a costal graft is reliable and provides an alternative option for resurfacing the articular surface with viable cartilage.

Keywords

rib cartilage graft - SNAC - SLAC - Kienböck disease - wrist surgery - interposition and free spacer surgery
 

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