scholarly journals Free Vascularized Medial Femoral Condyle Bone Graft for Scaphoid Nonunion with Poor Prognosis Factors

2021 ◽  
Author(s):  
Sam-Guk Park ◽  
Bum-Jin Shim ◽  
Hyun-Gyu Seok
Keyword(s):  
Prognostic Factors ◽  
Bone Graft ◽  
Avascular Necrosis ◽  
Poor Prognosis ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Scaphoid Nonunion ◽  
Prognosis Factors ◽  
Carpal Height

Purpose: Authors attempt to evaluate the clinical and radiographic results of the treatment of scaphoid nonunion with poor prognostic factors with the free vascularized medial femoral condyle bone graft. Methods: We operated on eight patients with avascular necrosis or prolonged nonunion of the scaphoid between January 2016 and July 2019. Wrist motion in terms of flexion, extension, and ulnar and radial deviation, a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the modified Mayo wrist score, scapholunate angle, and carpal height index were collected in the clinic setting preoperatively and at the latest follow-up in all patients Results: Eight patients with union achieved correction and maintenance of both scapholunate angle and carpal height index. The VAS pain scores significantly improved from 5.1 preoperatively to 3.3 postoperatively. There was a statistically significant improvement in the average DASH score at the final follow-up. Scapholunate relationships in the reconstructed wrists remained almost unchanged, with average scapholunate angles of 49.7° before surgery and 47.0° at the latest postoperative follow-up. There was no statistical significance between the number of poor prognosis factors and the time to union, but there was a positive correlation.Conclusion: It could help surgeons manage the scaphoid nonunion associated with poor prognostic factors such as avascular necrosis, carpal collapse (posttraumatic arthritis), prolonged nonunion, and failed prior scaphoid nonunion surgery.

Primary medial femoral condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis

2018 ◽  
Vol 44 (6) ◽  
pp. 600-606 ◽  
Author(s):  
Kathleen M. Kollitz ◽  
Nicholas Pulos ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Femoral Condyle ◽  
Primary Treatment ◽  
Medial Femoral Condyle ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Carpal Collapse ◽  
Time From Injury ◽  
Vascularized Bone

This study aimed to determine the outcome of free vascularized medial femoral condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Thirty of 32 patients healed at a median of 12 weeks. There was significant improvement from preoperative to postoperative lateral intrascaphoid angle, scapholunate angle, and radiolunate angle. Two scaphoids failed to unite; one patient underwent scaphoidectomy and four-corner fusion 15 months postoperatively after suffering a subsequent injury. Another patient underwent 1,2-intercompartmental supraretinacular artery-based vascularized bone grafting at 4 months postoperatively and then scaphoid excision with four-corner fusion 4 years later. The free vascularized medial femoral condyle bone graft restores scaphoid vascularity and architecture while promoting union in a subset of scaphoid nonunions that has historically been a clinical challenge. Level of evidence: IV

Free Vascularized Medial Femoral Condyle Bone Graft After Failed Scaphoid Nonunion Surgery

2018 ◽  
Vol 100 (16) ◽  
pp. 1379-1386 ◽  
Author(s):  
Nicholas Pulos ◽  
Kathleen M. Kollitz ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Bone Graft ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Scaphoid Nonunion

scholarly journals Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988426 ◽  
Author(s):  
John T. Stranix ◽  
Merisa L. Piper ◽  
Said C. Azoury ◽  
Geoffrey Kozak ◽  
Oded Ben-Amotz ◽  
...  
Keyword(s):  
Free Flap ◽  
Femoral Condyle ◽  
Donor Site ◽  
Case Series ◽  
Medial Femoral Condyle ◽  
Flap Reconstruction ◽  
Foot And Ankle ◽  
Osseous Union ◽  
Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

scholarly journals Medial Femoral Condyle Periosteal Free Flap: A Novel Technique for the Treatment of Avascular Necrosis of the Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Adam Saad ◽  
Megan L. Jimenez ◽  
Ryan Rogero ◽  
Sherif Saad ◽  
Brian S. Winters
Keyword(s):  
Surgical Technique ◽  
Avascular Necrosis ◽  
Short Form ◽  
Femoral Condyle ◽  
Case Series ◽  
Core Decompression ◽  
Lower Extremities ◽  
Medial Femoral Condyle ◽  
Functional Scores ◽  
Complex Procedure

Category: Hindfoot Introduction/Purpose: Avascular necrosis (AVN) of the talus is commonly caused by trauma and often requires surgical management. It is recommended that healthy patients, in pre-collapse stages, undergo joint preservation procedures. Good results have been published in patients in pre-collapse stages who undergo vascularized bone grafting. Although many graft options exist, more recently the medial femoral condyle (MFC) free vascularized graft has been introduced. This graft typically utilizes vascularized corticoperiosteal bone but can be modified to the use of solely periosteum, which theoretically decreases morbidity and operative time. There is limited research on the periosteal-only MFC flap to treat AVN of the talus. We present a case series and surgical technique utilizing a periosteal vascularized pedicle graft to teat AVN of the talus. Methods: A surgical technique is presented, in addition to a retrospective review of AVN of the talus of 6 lower extremities. Treatment included talus core decompression along with an ipsilateral medial femoral condyle free vascularized periosteal graft. All patients included were in the pre-collapse stage. Short-term clinical outcome measures of Foot & Ankle Ability Measure- Activities of Daily Living (FAAM-ADL) subscale, Short Form-12 (SF-12), and Visual Analog Scale (VAS) for pain were recorded for all patients post-operatively. Paired T-tests were used to compare pre- and post-operative functional scores. Post-operative MRIs were reviewed by a musculoskeletal radiologist. Results: The causes of AVN included trauma (2/6, 33%), sepsis (2/6, 33%), and idiopathic (2/6, 33%). Post-operative FAAM-ADL (P=0.004) and VAS (P=0.003) scores showed statistically significant improvement from pre-operative values at an average of 16.0 months (range, 6-28 months) after surgery. Additionally, all patients (100%) reported being “very satisfied” with their surgical outcome. There was 1 minor complication, with one patient reporting minimal paresthesias following surgery. Post-operative MRIs, taken at a mean of 12.7 months, demonstrated both resolution of marrow edema and soft tissue inflammation surrounding the areas of AVN and a lack of AVN progression in 100% of lower extremities, when compared to pre-operative MRIs. Conclusion: Medial femoral condyle free vascularized periosteal graft is a complex procedure which requires a team comprised of a foot & ankle surgeon and a plastic/hand surgeon familiar with microvascular surgery. This study shows promising initial results for the treatment of an extremely challenging diagnosis: AVN of the talus. Long-term, prospective studies are needed to confirm the findings presented in the current study.

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