Vascularized bone grafts for the treatment of carpal bone pathology

Brian M. Derby, Peter M. Murray, Alexander Y. Shin, Reuben A. Bueno, Christophe L. Mathoulin, Tim Ade, Michael W. Neumeister

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.

Original languageEnglish (US)
Pages (from-to)27-40
Number of pages14
JournalHand
Volume8
Issue number1
DOIs
StatePublished - 2013

Fingerprint

Carpal Bones
Pathology
Transplants
Bone and Bones
Wrist
Therapeutics
Bone Transplantation
Scaphoid Bone
Closed Fractures
Fracture Fixation
Osteonecrosis
Bone Fractures
Thigh
Necrosis
Hand

Keywords

  • Kienböck's
  • Preiser's
  • Scaphoid nonunions
  • Vascular bone grafts
  • VBG's

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Derby, B. M., Murray, P. M., Shin, A. Y., Bueno, R. A., Mathoulin, C. L., Ade, T., & Neumeister, M. W. (2013). Vascularized bone grafts for the treatment of carpal bone pathology. Hand, 8(1), 27-40. https://doi.org/10.1007/s11552-012-9479-0

Vascularized bone grafts for the treatment of carpal bone pathology. / Derby, Brian M.; Murray, Peter M.; Shin, Alexander Y.; Bueno, Reuben A.; Mathoulin, Christophe L.; Ade, Tim; Neumeister, Michael W.

In: Hand, Vol. 8, No. 1, 2013, p. 27-40.

Research output: Contribution to journalArticle

Derby, BM, Murray, PM, Shin, AY, Bueno, RA, Mathoulin, CL, Ade, T & Neumeister, MW 2013, 'Vascularized bone grafts for the treatment of carpal bone pathology', Hand, vol. 8, no. 1, pp. 27-40. https://doi.org/10.1007/s11552-012-9479-0
Derby, Brian M. ; Murray, Peter M. ; Shin, Alexander Y. ; Bueno, Reuben A. ; Mathoulin, Christophe L. ; Ade, Tim ; Neumeister, Michael W. / Vascularized bone grafts for the treatment of carpal bone pathology. In: Hand. 2013 ; Vol. 8, No. 1. pp. 27-40.
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