Lateral Femoral Trochlea Osteochondral Flap Reconstruction of Proximal Pole Scaphoid Nonunions

Christian M Windhofer; James P Higgins; Alexander Gaggl; Heinzi P Bürger

doi:10.1016/j.jhsa.2022.08.019

Lateral Femoral Trochlea Osteochondral Flap Reconstruction of Proximal Pole Scaphoid Nonunions

J Hand Surg Am. 2022 Nov 1:S0363-5023(22)00505-6. doi: 10.1016/j.jhsa.2022.08.019. Online ahead of print.

Authors

Christian M Windhofer¹, James P Higgins², Alexander Gaggl³, Heinzi P Bürger⁴

Affiliations

¹ Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria; Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Vienna, Austria. Electronic address: christian.windhofer@gmail.com.
² The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
³ Department of Oral and Maxillofacial Surgery, General Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁴ Privat Hospital Maria Hilf, Klagenfurt, Austria.

PMID: 36333244
DOI: 10.1016/j.jhsa.2022.08.019

Abstract

Purpose: The medial femoral trochlea flap has been described as a method of scaphoid proximal pole nonunion reconstruction when the proximal pole is deemed nonsalvageable. The lateral femoral trochlea (LFT) is an alternative donor site providing a comparable vascularized convex osteochondral flap. We describe the technique and outcomes of our first 17 cases of LFT flap reconstruction of the proximal scaphoid pole with a minimum follow-up of 14 months.

Methods: Seventeen of the first 24 patients who underwent LFT scaphoid reconstruction at 3 institutions were able to be contacted for clinical follow-up and chart reviews. We recorded patient age and sex, duration of nonunion, number of previous surgical procedures, details of surgical technique, achievement of osseous union, complications, additional postoperative procedures, preoperative and postoperative pain, and range of motion. Preoperative and postoperative scapholunate and radiolunate angles were analyzed on x-rays and achievement of osseous union on computerized tomography scans.

Results: The average age of patients included was 35 years (range, 16-55 years). Follow-up data were recorded at an average of 33 months (range, 14-62 months). Ten patients had previous procedures (average, 1; range, 0-2). Median duration from trauma to LFT was 3.4 years (range, 8 months-12 years) among patients who had a recognized date of injury. Osseous healing was achieved in 16 of 17 patients and confirmed by computerized tomograpy scan. Twelve patients reported complete pain relief, while 5 reported partial pain relief. Final postoperative range of motion was 59°extension (range, 30°-85°) and 50° flexion (range, 10°-80°), which was comparable to preoperative values. Preoperative (59°) and postoperative (55°) scapholunate angles were similar to normal wrists.

Conclusion: Vascularized LFT flaps provide an alternative donor site for vascularized osteochondral reconstruction of proximal pole scaphoid nonunion. Rate of union, range of motion, and pain relief are similar to reported results with medial femoral trochlea flap reconstruction.

Type of study/level of evidence: Therapeutic IV.

Keywords: Lateral femoral trochlea flap; osteochondral flap; scaphoid nonunion; vascularized bone.