Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion
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ORIGINAL PAPER
Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion S. Matić 1,2 & Č. Vučković 1 & A. Lešić 1,2 & I. Glišović Jovanović 1 & D. Polojac 1 & S. Dučić 2,3 & M. Bumbaširević 1,2 Received: 10 September 2020 / Accepted: 22 September 2020 # SICOT aisbl 2020
Abstract Introduction Fractures of the scaphoid account for 60–70% of all wrist bone fractures. The results of treatment in terms of bone healing vary depending on the type and location of the fracture, the time elapsed since the injury, the type of surgical treatment. Nonunion occurs in 5–15% of the cases on average. The purpose of this paper is to compare the surgical techniques and results of treating scaphoid nonunion (SNU) with osteoplastic xenografts of bovine origin or a vascularized autograft of the distal part of the dorsal radius. Methods We compare two groups of patients with symptomatic SNU, treated surgically with either a vascularized graft (n = 15) or a xenograft of bovine origin (n = 15). In the presurgical stage, the demographic characteristics of the patients, the time elapsed between injury and surgery, and classification of the injury (Schonberg, Herbert–Fisher, and Geissler–Slade) were recorded. One year following surgery, bone healing, total duration of the treatment, complications, the Mayo wrist score, and answers to the DASH questionnaire were analyzed. Results No statistically significant differences between the two groups of patients were observed for bone healing (86.7% vs 80%) or functional results. A highly significant difference was observed with respect to duration of the surgical intervention in favor of xenografts. Conclusion The xenograft method is simple and relatively acceptable, providing good results in terms of healing and functionality. Keywords Scaphoid nonunion . Vascularized bone graft . Bone grafting . Xenograft
Introduction Fractures of the scaphoid bone occur prevalently in young men, in cases of wrist extension greater than 95° under a low intensity energy force [1, 2]. Nonunion of fractures is seen in 5–15% of the cases on average [2–4]. The scaphoid bone bridges the proximal and distal rows of the wrist bones. Almost 80% of the scaphoid bone surface is covered with cartilage. There are several ligament attachments and one dominant nutritive artery, which is a branch of the * I. Glišović Jovanović [email protected] 1
Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia
2
School of Medicine, University of Belgrade, Belgrade, Serbia
3
University Children Hospital, Belgrade, Serbia
radial artery. Interosseal vascularization of the proximal bone pole (70–80%) originates from the radial artery branch which enters the bone along the dorsal ridge at the level of the waist. Given such anatomy, after a fracture there is a risk of vascular insufficiency and consequential development of avascular necrosis [5], particularly of the upper bone pole [1]. Delay in diagnosis leads to a variety of adverse outcomes such as delayed
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