Artikel
Salvage of the proximal scaphoid: A retrospective comparison of Medial Femoral Trochlear Osteocartilaginous graft and Costo-osteochondral graft with a minimum 2 year follow-up
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Autoren
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John Galbraith
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Cameron Keating
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Chris Powell
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Charlie Bain
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Anthony Berger
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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David McCombe
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Eugene Ek
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
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Stephen Tham
- St Vincents Hospital Hand Unit, Dandenong Hospital Hand Unit, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Introduction: The free vascularized medial femoral trochlear (MFT) osteochondral graft and the costo-osteochondral graft (COG) are two options for the salvage of the fragmented proximal scaphoid. The aim of this study was to compare outcomes of these techniques at a minimum of 2 years postoperatively.
Methods: Institutional ethics approval was obtained to review all patients who had undergone either a MFT or COG for fractures of the proximal third of the scaphoid over the last 20 years. Baseline demographic information was collected, including age, sex, hand dominance and pre-operative procedures. Patients returned for clinical review and outcome measures were recorded (DASH, PRWE and VAS). Range of motion of the wrist and grip strength were measured. Follow-up radiographs were reviewed to identify degenerative changes, carpal height, lunocapitate and radiolunate angles.
Results: There were 12 MFT and 21 COG procedures performed, of which 9 MFT and 12 COG patients presented for review. The MFT group were younger (mean 30.6 Vs 38.3 years, p=0.01) and had significantly shorter follow-up (mean 35 Vs 124 months, p< 0.001). The MFT group had significantly better postoperative VAS (1.4 Vs 3.3, p=0.05), but there was no significant difference in postoperative DASH (15.3 Vs 12.7), PRWE (23.3 Vs 16.5) or Grip strength (41 Vs 35.6 kg)(p >0.05). There was no significant difference in postoperative wrist Flexion/Extension arc (65°Vs 77.7°), Ulnar/Radial arc (36.1° Vs 34.2°) and Pronation/Supination arc (159.4° Vs 158.9°)(p>0.05). In the MFT group there was radiographic evidence of beaking of the radial styloid in 6 wrists. In the COG group all patients had mid-carpal and radiocarpal osteoarthritis. The two groups had a markedly different complication profile. In the COG group 1 patient required a total wrist fusion 2 years postoperatively. There were 2 pneumothoraces, 1 joint infection and 1 radial styloidectomy. In the MFT group 1 patient underwent scaphoid excision and four corner fusion at 7 months, 1 patient had notable knee pain and 8 patients complained of some knee discomfort not sufficient to affect their daily activities.
Discussion: The survivability of the COG group is notable at 10 years with good outcomes despite the radiological changes. The intermediate results of the MFT group are promising and potentially will have better long-term outcome, because of the similarity in arc of curvature of the MFT to the proximal scaphoid and the presence of articular cartilage.
