Artikel
Midterm results of scaphoid reconstruction using a free vascularised osteochondral medial femoral condyle flap
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Autoren
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Karlheinz Kalb
- Rhön Klinikum AG - Klinik für Handchirurgie, Bad Neustadt, Germany
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Annelie Wiebel
- Rhön Klinikum AG - Klinik für Handchirurgie, Bad Neustadt, Germany
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Reconstruction of a destructed proximal pole in scaphoid non-union using a free vasularised medial femoral condyle flap is a sophisticated operation with promising early results published. As there is a lack of midterm results in the literature we analysed our midterm results of this procedure.
Methods: Between 2011 and 2016 76 patients were operated in our hospital using a free vasularised medial femoral condyle flap to replace a proximal scaphoid pole in non-unions. In a retrospective study 44 of these patients (41 men/3 women) with a mean age of 31 (20 - 53) years were reexamined with a mean folllow-up time of 44 (13-77) months. The examination included the patients history, a clinical examination, establishment of DASH-score and Krimmer-score and standard x-rays of the wrist. 31 out of 44 patients had a history of at least one scaphoid reconstruction before.
Results and Conclusions: Bony consolidation was found in 35 out of 44 patients (80%), partial consolidation in 2 (5%) and persisting non-union in 7 (15%). 5 (11%) patients had had a salvage procedure in the meantime: 4 four corner fusions and 1 proximal row carpectomy. In 12 out of 44 cases the shape of the reconstructed scaphoid was not sufficient especially in complex situations with large bony defects and fixed scaphoid deformity. Osteoarthritic changes of varying degrees were found in 17 patients.
Clinically the patients without salvage procedures had good results with a mean Krimmer-score of 80 (38-100), a mean range of motion of 90°, a mean grip strength of 81% of the contralateral side and a mean DASH-score of 15 (0-56), whereas the 5 patients with salvage procedures had worse results with a mean Krimmer-score of 52 (25-70), a mean range of motion of 47°, a mean grip strength of 58% and a mean DASH-score of 19 (8-27). 39 out of 44 patients would choose the same operation once again.
Scaphoid reconstruction using a free vascularised medial femoral condyle flap yields good clinical and radiological midterm results in the majority of these complex cases, but usually not a complete functional recovery. Furthermore our results demonstrate a considerable number of complications which in some cases require salvage procedures with not satisfying results. These aspects have to be discussed with future patients to enable them to have realistic and not enthusiastic expectations.
