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Published in: HAND 3/2015

01-09-2015

Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report

Authors: Oded Ben-Amotz, Christine Ho, Douglas M. Sammer

Published in: HAND | Issue 3/2015

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Abstract

Background

The medial femoral condyle vascularized bone graft has grown in popularity for treating recalcitrant fracture non-unions and has become particularly useful in treating scaphoid non-union with avascular necrosis of the proximal pole. The medial femoral condyle is an excellent source of dense, well-vascularized bone and results in minimal donor site morbidity.

Methods

We describe an unusual case of chronic scaphoid non-union and total scaphoid avascular necrosis in a skeletally immature patient. Scaphoid reconstruction was performed with a vascularized medial femoral condyle graft, with successful graft incorporation, and restoration of pain-free wrist motion.

Conclusions

Technical considerations for harvest of the medial femoral condyle bone graft in the skeletally immature patient are discussed.
Literature
1.
go back to reference Choudry UH, Bakri K, Moran SL, Karacor Z, Shin AY. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg. 2008;60(2):174–80.PubMedCrossRef Choudry UH, Bakri K, Moran SL, Karacor Z, Shin AY. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg. 2008;60(2):174–80.PubMedCrossRef
2.
go back to reference Cooney 3rd WP, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg [Am]. 1980;5(4):343–54.CrossRef Cooney 3rd WP, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg [Am]. 1980;5(4):343–54.CrossRef
3.
go back to reference Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–7.PubMed Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–7.PubMed
4.
go back to reference De Smet L. Treatment of non-union of forearm bones with a free vascularised corticoperiosteal flap from the medial femoral condyle. Acta Orthop Belg. 2009;75:611–5.PubMed De Smet L. Treatment of non-union of forearm bones with a free vascularised corticoperiosteal flap from the medial femoral condyle. Acta Orthop Belg. 2009;75:611–5.PubMed
5.
go back to reference Del Pinal F, Garcia-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A. Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg. 2007;32E:135–42. Del Pinal F, Garcia-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A. Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg. 2007;32E:135–42.
6.
go back to reference Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg (Br). 1989;71(2):307–10. Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg (Br). 1989;71(2):307–10.
7.
go back to reference Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg [Am]. 2000;25(3):507–19.CrossRef Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg [Am]. 2000;25(3):507–19.CrossRef
8.
go back to reference Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery. 1994;15:305–15.PubMedCrossRef Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery. 1994;15:305–15.PubMedCrossRef
9.
go back to reference Eddeland A, Eiken O, Hellgren E, Ohlsson NM. Fractures of the scaphoid. Scand J Plast Reconstr Surg. 1975;9(3):234–9.PubMedCrossRef Eddeland A, Eiken O, Hellgren E, Ohlsson NM. Fractures of the scaphoid. Scand J Plast Reconstr Surg. 1975;9(3):234–9.PubMedCrossRef
10.
go back to reference Espinosa GA, Michael AS, Wilbur AC, McKusick MA, Kennard DR, Otto R. Osteonecrosis of the distal pole of the carpal navicular following fracture. Mil Med. 1986;151:663–5.PubMed Espinosa GA, Michael AS, Wilbur AC, McKusick MA, Kennard DR, Otto R. Osteonecrosis of the distal pole of the carpal navicular following fracture. Mil Med. 1986;151:663–5.PubMed
11.
go back to reference Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus. Clin Orthop Relat Res. 2001;383:47–59.PubMedCrossRef Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus. Clin Orthop Relat Res. 2001;383:47–59.PubMedCrossRef
12.
go back to reference Friedrich JB, Pederson WC, Bishop AT, Galaviz P, Chang J. New workhorse flaps in hand reconstruction. Hand (NY). 2012;7(1):45–54.CrossRef Friedrich JB, Pederson WC, Bishop AT, Galaviz P, Chang J. New workhorse flaps in hand reconstruction. Hand (NY). 2012;7(1):45–54.CrossRef
13.
go back to reference Fuchs B, Steinmann SP, Bishop AT. Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle. J Shoulder Elbow Surg. 2005;14(3):264–8.PubMedCrossRef Fuchs B, Steinmann SP, Bishop AT. Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle. J Shoulder Elbow Surg. 2005;14(3):264–8.PubMedCrossRef
14.
go back to reference Gabl M, Pechlaner S, Zimmermann R. Free vascularized iliac bone graft for the treatment of scaphoid nonunion with avascular proximal fragment. Oper Orthop Traumatol. 2009;21(4–5):386–95.PubMedCrossRef Gabl M, Pechlaner S, Zimmermann R. Free vascularized iliac bone graft for the treatment of scaphoid nonunion with avascular proximal fragment. Oper Orthop Traumatol. 2009;21(4–5):386–95.PubMedCrossRef
15.
go back to reference Grant I, Berger AC, Ireland DC. A vascularised bone graft from the medial femoral condyle for recurrent failed arthrodesis of the distal interphalangeal joint. Br J Plast Surg. 2005;58(7):1011–3.PubMedCrossRef Grant I, Berger AC, Ireland DC. A vascularised bone graft from the medial femoral condyle for recurrent failed arthrodesis of the distal interphalangeal joint. Br J Plast Surg. 2005;58(7):1011–3.PubMedCrossRef
16.
go back to reference Henry M. Genicular corticoperiosteal flap salvage of resistant atrophic non-union of the distal radius metaphysis. Hand Surg. 2007;12(3):211–5.PubMedCrossRef Henry M. Genicular corticoperiosteal flap salvage of resistant atrophic non-union of the distal radius metaphysis. Hand Surg. 2007;12(3):211–5.PubMedCrossRef
17.
go back to reference Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg (Br). 1984;66(1):114–23. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg (Br). 1984;66(1):114–23.
18.
go back to reference Hertel R, Masquelet AC. The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis. Surg Radiol Anat. 1989;11(4):257–62.PubMedCrossRef Hertel R, Masquelet AC. The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis. Surg Radiol Anat. 1989;11(4):257–62.PubMedCrossRef
19.
go back to reference Hugon S, Koninckx A, Barbier O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat. 2010;32(9):817–25.PubMedCrossRef Hugon S, Koninckx A, Barbier O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat. 2010;32(9):817–25.PubMedCrossRef
20.
go back to reference Iqbal S, Higgins G, Ratcliffe P. Avascular necrosis of both poles of a paediatric waist of scaphoid fracture. Inj Extra. 2007;38:247–9.CrossRef Iqbal S, Higgins G, Ratcliffe P. Avascular necrosis of both poles of a paediatric waist of scaphoid fracture. Inj Extra. 2007;38:247–9.CrossRef
21.
go back to reference Jones Jr DB, Burger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg. 2008;90A:2616–25. Jones Jr DB, Burger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg. 2008;90A:2616–25.
22.
go back to reference Jones Jr DB, Bürger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2:169–83.PubMed Jones Jr DB, Bürger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2:169–83.PubMed
23.
go back to reference Jones Jr DB, Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010;125:1176–84.PubMedCrossRef Jones Jr DB, Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010;125:1176–84.PubMedCrossRef
24.
go back to reference Jones Jr DB, Rhee PC, Bishop AT, Shin AY. Free vascularized medial femoral condyle autograft for challenging upper extremity nonunions. Hand Clin. 2012;28(4):493–501.PubMedCrossRef Jones Jr DB, Rhee PC, Bishop AT, Shin AY. Free vascularized medial femoral condyle autograft for challenging upper extremity nonunions. Hand Clin. 2012;28(4):493–501.PubMedCrossRef
25.
go back to reference Jones Jr DB, Shin AY. Medial femoral condyle vascularized bone grafts for scaphoid nonunions. Chir Main. 2010;29 Suppl 1:93–103.CrossRef Jones Jr DB, Shin AY. Medial femoral condyle vascularized bone grafts for scaphoid nonunions. Chir Main. 2010;29 Suppl 1:93–103.CrossRef
26.
go back to reference Kaminski A, Burger H, Muller EJ. Free vascularised corticoperiosteal bone flaps in the treatment of non-union of long bones: an ignored opportunity? Acta Orthop Belg. 2008;74:235–9.PubMed Kaminski A, Burger H, Muller EJ. Free vascularised corticoperiosteal bone flaps in the treatment of non-union of long bones: an ignored opportunity? Acta Orthop Belg. 2008;74:235–9.PubMed
28.
go back to reference Kobayashi S, Kakibuchi M, Masuda T, Ohmori K. Use of vascularized corticoperiosteal flap from the femur for reconstruction of the orbit. Ann Plast Surg. 1994;33:351–7.PubMedCrossRef Kobayashi S, Kakibuchi M, Masuda T, Ohmori K. Use of vascularized corticoperiosteal flap from the femur for reconstruction of the orbit. Ann Plast Surg. 1994;33:351–7.PubMedCrossRef
29.
go back to reference Larson AN, Bishop AT, Shin AY. Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis. Tech Hand Upper Extrem Surg. 2007;11:246–58.CrossRef Larson AN, Bishop AT, Shin AY. Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis. Tech Hand Upper Extrem Surg. 2007;11:246–58.CrossRef
30.
go back to reference Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg (Br). 1981;63B(2):225–30. Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg (Br). 1981;63B(2):225–30.
31.
go back to reference Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972;54(8):1612–32.PubMed Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972;54(8):1612–32.PubMed
32.
go back to reference Martin D, Bitonti-Grillo C, De BJ, Schott H, Mondie JM, Baudet J, et al. Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur. Br J Plast Surg. 1991;44:397–402.PubMedCrossRef Martin D, Bitonti-Grillo C, De BJ, Schott H, Mondie JM, Baudet J, et al. Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur. Br J Plast Surg. 1991;44:397–402.PubMedCrossRef
33.
go back to reference Muramatsu K, Doi K, Ihara K, Shigetomi M, Kawai S. Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft. Acta Orthop Scand. 2003;74:95–7.PubMedCrossRef Muramatsu K, Doi K, Ihara K, Shigetomi M, Kawai S. Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft. Acta Orthop Scand. 2003;74:95–7.PubMedCrossRef
34.
go back to reference Rao SS, Sexton CC, Higgins JP. Medial femoral condyle flap donor-site morbidity: a radiographic assessment. Plast Reconstr Surg. 2013;131(3):357e–62.PubMedCrossRef Rao SS, Sexton CC, Higgins JP. Medial femoral condyle flap donor-site morbidity: a radiographic assessment. Plast Reconstr Surg. 2013;131(3):357e–62.PubMedCrossRef
35.
go back to reference Reddy AS, Frederick RW. Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med. 1998;26(3):415–9.PubMed Reddy AS, Frederick RW. Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med. 1998;26(3):415–9.PubMed
36.
go back to reference Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-A:759–68.PubMed Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-A:759–68.PubMed
37.
go back to reference Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg. 1991;87(2):290–8.PubMedCrossRef Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg. 1991;87(2):290–8.PubMedCrossRef
38.
go back to reference Sammer DM, Bishop AT, Shin AY. Vascularized medial femoral condyle graft for thumb metacarpal reconstruction: case report. J Hand Surg. 2009;34A:715–8.CrossRef Sammer DM, Bishop AT, Shin AY. Vascularized medial femoral condyle graft for thumb metacarpal reconstruction: case report. J Hand Surg. 2009;34A:715–8.CrossRef
39.
go back to reference Sherman SB, Greenspan A, Norman A. Osteonecrosis of the distal pole of the carpal scaphoid following fracture: a rare complication. Skelet Radiol. 1983;9:189–91.CrossRef Sherman SB, Greenspan A, Norman A. Osteonecrosis of the distal pole of the carpal scaphoid following fracture: a rare complication. Skelet Radiol. 1983;9:189–91.CrossRef
40.
go back to reference Szabo RM, Manske D. Displaced fractures of the scaphoid. Clin Orthop Relat Res. 1988;230:30–8.PubMed Szabo RM, Manske D. Displaced fractures of the scaphoid. Clin Orthop Relat Res. 1988;230:30–8.PubMed
41.
go back to reference Van Dijck C, Mattelaer B, De Degreef I, De Smet L. Arterial anatomy of the free vascularised corticoperiosteal graft from the medial femoral condyle. Acta Orthop Belg. 2011;77(4):502–5.PubMed Van Dijck C, Mattelaer B, De Degreef I, De Smet L. Arterial anatomy of the free vascularised corticoperiosteal graft from the medial femoral condyle. Acta Orthop Belg. 2011;77(4):502–5.PubMed
42.
go back to reference Yamamoto H, Jones Jr DB, Moran SL, Bishop AT, Shin AY. The arterial anatomy of the medial femoral condyle and its clinical implications. J Hand Surg Eur Vol. 2010;35(7):569–74.PubMedCrossRef Yamamoto H, Jones Jr DB, Moran SL, Bishop AT, Shin AY. The arterial anatomy of the medial femoral condyle and its clinical implications. J Hand Surg Eur Vol. 2010;35(7):569–74.PubMedCrossRef
Metadata
Title
Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report
Authors
Oded Ben-Amotz
Christine Ho
Douglas M. Sammer
Publication date
01-09-2015
Publisher
Springer US
Published in
HAND / Issue 3/2015
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-014-9711-1

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