J Wrist Surg 2020; 09(03): 186-189
DOI: 10.1055/s-0039-3401015
Special Review: Surgeons' Level of Expertise
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medial Femoral Trochlea Graft for Scaphoid Waist Nonunion: A Case Report and Review of the Literature

Bruno E. Crepaldi
1   St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
,
Cameron Keating
1   St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
,
Eugene T. Ek
2   Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
3   Dandenong Hospital Hand Unit, Dandenong, Victoria, Australia
,
Stephen K. Y. Tham
1   St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
2   Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
3   Dandenong Hospital Hand Unit, Dandenong, Victoria, Australia
› Author Affiliations
Further Information

Publication History

26 November 2018

01 November 2019

Publication Date:
17 December 2019 (online)

Abstract

The medial femoral trochlea (MFT) of the knee is a donor site for convex osteochondral vascularized bone that has been used for the salvage of fractures of the proximal pole of the scaphoid. Chronic nonunited fractures of the scaphoid may lead to a sequence of degenerative change often referred to as scaphoid nonunion advance collapse. The vascularized MFT osteochondral graft has been reported as a salvage procedure for fractures of the proximal pole of the scaphoid, in situations where fixation is not an option. In this “Special review,” we describe the technique of free vascularized MFT graft in a case in which the nonunited scaphoid fracture was associated with segmental loss of the articular surface of the scaphoid waist. Given the likely progression of arthritis, if left untreated, we elected to treat this by replacing the lost articular surface using a vascularized intercalary osteochondral MFT graft between the nonunited scaphoid segments.

 
  • References

  • 1 Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am 2000; 25 (03) 507-519
  • 2 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 (04) 690-700
  • 3 Hugon S, Koninckx A, Barbier O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat 2010; 32 (09) 817-825
  • 4 Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am 1987; 12 (04) 514-519
  • 5 Higgins JP, Bürger HK. Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications. J Reconstr Microsurg 2014; 30 (07) 483-490
  • 6 Higgins JP, Bürger HK. The use of osteochondral flaps in the treatment of carpal disorders. J Hand Surg Eur Vol 2018; 43 (01) 48-56
  • 7 Windhofer C, Wong VW, Larcher L, Paryavi E, Bürger HK, Higgins JP. Knee donor site morbidity following harvest of medial femoral trochlea osteochondral flaps for carpal reconstruction. J Hand Surg Am 2016; 41 (05) 610-614.e1
  • 8 Wagner ER, Werthel JD, Elhassan BT, Moran SL. Proximal row carpectomy and 4-corner arthrodesis in patients younger than age 45 years. J Hand Surg Am 2017; 42 (06) 428-435
  • 9 Düppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I. Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg Am 1994; 76 (02) 249-252