gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Vascularized versus non-vascularized bone grafts for scaphoid non-union: evidence and new findings

Meeting Abstract

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  • presenting/speaker Gernot Schmidle - Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
  • Rohit Arora - Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
  • Tobias Kastenberger - Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
  • Markus Gabl - Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1745

doi: 10.3205/19ifssh0384, urn:nbn:de:0183-19ifssh03840

Veröffentlicht: 6. Februar 2020

© 2020 Schmidle et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: The main risk factors for a scaphoid non-union (SNU) are fracture displacement, location and vascular supply. The treatment with vascularized (VBGs) or non-vascularized bone grafts (NVGBs) is a debated issue. In clinical practice VBGs are indicated in cases of avascular necrosis (AVN) of the proximal pole and when previous surgery has failed. However, there is no high-level evidence, the role of vascularity as indicator for SNU healing is unclear and little is known about the biology of bone healing.

Methods: Based on a literature review we analyzed evidence of VBG versus NVBG treatment. Union rates were compared and the quality of evidence was evaluated.

In a study with 68 patients (42 fractures, 26 SNUs) we compared how well the different imaging modalities can display fracture patterns, stability and vitality.

In a second study we assessed the bone healing capacity (BHC) of SNUs in 33 patients by histological analyses. We compared these results to CT parameters of fracture location and bone structure.

Results and Conclusions: Most of the studies found are case series with retrospective, non-randomized designs and a high risk of bias. Higher union rates are usually obtained in the absence of AVN, however the use of a wide range of definitions and assessment methods make a valid comparison difficult and the role of vascularity in SNU healing unclear.

Our study regarding imaging modalities showed that the 3D analysis provides complementary information in comparison to two-dimensional imaging. Fracture location and extension of fracture lines can be best analyzed by 3D imaging and give important information about stability and potential vascularity.

The second study showed a correlation of bone healing capacity and 2D CT parameters, with higher BHC in cases with normal trabecular structure and lower BHC in cases with fragmentation. The 3D CT fracture location showed lower BHC in completely intraarticular proximal pole non-unions.

The choice of bone grafting cannot be based on evidence and further studies are necessary to determine and precise the indications of VBG treatment.

CT parameters of bone structure and fracture location can predict bone healing and are helpful to choose the appropriate SNU treatment in clinical practice.