Free Vascularized versus Non Vascularized Medial Femoral Condyle Grafting in Treatment of Scaphoid Nonunion with Humpback Deformity
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- Category: Vol. 85, June 2017
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Free Vascularized versus Non Vascularized Medial Femoral Condyle Grafting in Treatment of Scaphoid Nonunion with Humpback Deformity, ASHRAF N. MOHARRAM, AYMAN M. MANSOUR, AYMAN A. SHAHEEN, MOSTAFA EZZAT and ISLAM ABOU-YOUSSEF
Abstract
Objectives: The purpose of this study was to compare the efficiency of free vascularized versus non vascularized grafting in advanced scaphoid nonunion with humpback deformity.
Patients and Methods: From June 2013 to June 2016, 30 patients with scaphoid nonunion with humpback deformity were included in the study. 17 were treated by non-vascularized and 13 by free vascularized medial femoral condyle grafting. The mean age at the time of surgery was 23.87±5.44 years (range 16-46 yeas). All patients were males. Right side were affected in 18 patients and left side in 12. Mean nonunion time was 20.93±26.96 months. Patients were followed-up for at least 6 months for union assessment with mean follow-up period 9.57 months.
Results: There was no statistically significant difference between both groups regarding union rate, union time (12 (70.5%) out of 17 patients in the non-vascularized group united with mean time of union 12.36±2.16 months. 9 (69.2%) out of 13 patients in the free group united with mean time 12.89±3.33 months) and final MMWS (70 mean score for non-vascularized versus 69 mean score for vascularized). However, there were statistically significant difference between both groups regarding complication rate [(5.9%) in non-vascularized group versus (46.2%) in the free group] and mean operative time (1.59 hours in non-vascularized group versus 4.00 hours in the free group).
Conclusion: In advanced scaphoid nonunion with flexion deformity; non-vascularized grafting is still a simple valid option with low complication rate. Free medial condyle grafting is more technically difficult and time consuming operation. It can achieve high union rates if early post-operative complication like graft extrusion was avoided.