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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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Zaidenberg’s pedicled vascularized bone-grafting for reconstruction of scaphoid-nonunions – effects and functional outcome in a series of 49 cases

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  • presenting/speaker Ben Schacher - MVZ Curadocs, Berlin, Germany
  • Richarda Böttcher - Unfallkrankenhaus Berlin, Berlin, Germany
  • Arnulf Vogel - Unfallkrankenhaus Berlin, Berlin, Germany
  • Ariane Asmus - Unfallkrankenhaus Berlin, Berlin, Germany
  • Simon Kim - Universitätsmedizin Greifswald, Greifswald, Germany
  • Andreas Eisenschenk - Dieter Buck-Gramko Stiftungsprofessur, Hand- und funktionelle Mikrochirurgie, Universitätsmedizin Greifswald, Greifswald, Germany
  • Frank Eichenauer - Unfallkrankenhaus Berlin, Berlin, Germany

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. DocIFSSH19-999

doi: 10.3205/19ifssh1206, urn:nbn:de:0183-19ifssh12065

Published: February 6, 2020

© 2020 Schacher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Nonunions of the Scaphoid can result after proximal fractures, failed surgical reconstruction and avascular fragment necrosis. Vascularized bone grafts in various techniques have been proven to be an effective treatment. They can be harvested as pedicled grafts from the direct vicinity of the wrist or as free transplants from other regions. A well-known pedicled vascularized bone graft for reconstruction of the scaphoid was described by C. Zaidenberg in 1991.

Methods: Between 2008 and 2016 a cohort of 49 consecutive patients underwent vascularized bone-grafting, pedicled on the 1,2 intercompartimental, supraretinacular artery in a modified technique based on Zaidenbergs description.

The indication for pedicled grafting, the operative procedure, aftercare and diagnostics to validate consolidation after treatment were prospectively standardized.

We present radiologic outcome/consolidation rates, characteristics of the group and follow-up data over 2 years including functional scores and quality-of-life data until the year 2018.

Results and Conclusions: Impaired perfusion of scaphoid fragments in preoperative contrast-enhanced MRIs indicated for the use of pedicled grafting in this study on the above described cohort. Consolidation could be shown in 37 of 49 cases in CT scans performed after 6 month. Treatment failure correlated with the severity of changes in preoperative MRI. Functional outcomes showed a frequent loss in range of motion of the affected wrist even after successful treatment/consolidation.