Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis / 中华显微外科杂志

ABSTRACT

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.