Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results

Cameron Keating; David McCombe; Christopher A Powell; Peter Maloney; Eugene T Ek; Stephen K Tham

doi:10.1016/j.jhsa.2020.10.014

Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results

J Hand Surg Am. 2021 Mar;46(3):248.e1-248.e9. doi: 10.1016/j.jhsa.2020.10.014. Epub 2020 Nov 28.

Authors

Cameron Keating¹, David McCombe², Christopher A Powell¹, Peter Maloney³, Eugene T Ek⁴, Stephen K Tham⁵

Affiliations

¹ Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia.
² Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia.
³ Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.
⁴ Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.
⁵ Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia. Electronic address: stham@bigpond.net.au.

PMID: 33257054
DOI: 10.1016/j.jhsa.2020.10.014

Abstract

Purpose: To report the clinical and radiological outcomes after medial femoral trochlear (MFT) osteochondral graft for the salvage of proximal scaphoid fractures with a minimum 2-year follow-up.

Methods: A retrospective review was performed of patients with comminuted fractures of the proximal scaphoid treated by excision of the proximal pole and replacement with free vascularized MFT osteochondral graft. Demographic data, objective and radiographic measurements, and patient-reported outcome measures of the upper limb and knee were collected. Pain was assessed by completion of a visual analog scale (VAS).

Results: Between February 2014 and May 2015, 12 MFT osteochondral grafts were performed. Eight patients were available for follow-up at a mean of 34 months (range, 28-39 months). The mean range of wrist flexion was 31° (range, 15°-60°), extension was 34° (range, 5°-60°), radial deviation was 9° (range, 0°-20°), ulnar deviation was 28° (range, 10°-45°) and grip strength was 42 kg (range, 25-53 kg). The median wrist pain, as measured by VAS, was 0.7 (mean, 1.3; range, 0-6). The average follow-up scapholunate, radiolunate, and radioscaphoid angles were 58.9° (range, 44°-93°), 12.9° (range, 0°-30°), and 46.0° (range, 35°-63°), respectively. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 13.9 (range, 3-43) and Patient Rated Wrist Evaluation (PRWE) score was 22.4 (range, 2-68). The mean postoperative Oxford Knee Score was 42 (range, 14-48). One patient suffered notable knee pain at 37-month follow-up. One patient suffered notable pain on the radial side of the wrist and underwent scaphoid excision and 4-corner arthrodesis.

Conclusions: Replacement of the fragmented proximal scaphoid by MFT graft is an alternative to other salvage options and most patients can expect pain relief and acceptable wrist motion. These results need to be balanced against the potential for donor-site morbidity.

Type of study/level of evidence: Therapeutic V.

Keywords: Avascular necrosis; bone graft; fracture; medial femoral trochlear; scaphoid.

MeSH terms

Femur
Follow-Up Studies
Fractures, Ununited*
Hand Strength
Humans
Range of Motion, Articular
Retrospective Studies
Scaphoid Bone* / diagnostic imaging
Scaphoid Bone* / surgery
Wrist Joint