Vascularized Scapular Grafting for Treatment of Osteonecrosis of the Humeral Head

ABSTRACT

Eight dissections in four embalmed cadavers were performed to investigate the possibility of vascularized scapular grafting for osteonecrosis of the humeral head. When the angular branch was used as the nutrient vessel, the mean length of the vascular pedicle was 12.4 cm, which was sufficient for transferring the scapula into the humeral head. Based on the anatomical study, a 27-year-old man with corticosteroid-induced osteonecrosis of the right humeral head was treated by vascularized scapular grafting. The pedicled vascularized scapula was successfully transferred into the humeral head using the angular branch. The patient's right shoulder pain disappeared following surgical recovery. He had no limitations of right shoulder motion 3 years after the surgery. Magnetic resonance imaging at 1 year after the surgery indicated revascularization of the humeral head. The humeral head did not collapse during a 3-year follow-up with radiographic evaluation. This procedure has the potential to be a new joint-preserving procedure for osteonecrosis of the humeral head.

KEYWORDS

Vascularized bone - scapula - osteonecrosis - humeral head

REFERENCES

• 1 Cruess R L. Steroid-induced avascular necrosis of the head of the humerus. Natural history and management.  J Bone Joint Surg Br. 1976;  58 313-317
• 2 L'Insalata J C, Pagnani M J, Warren R F, Dines D M. Humeral head osteonecrosis: clinical course and radiographic predictors of outcome.  J Shoulder Elbow Surg. 1996;  5 355-361
• 3 Hasan S S, Romeo A A. Nontraumatic osteonecrosis of the humeral head.  J Shoulder Elbow Surg. 2002;  11 281-298
• 4 Mont M A, Payman R K, LaPorte D M, Petri M, Jones L C, Hungerford D S. Atraumatic osteonecrosis of the humeral head.  J Rheumatol. 2000;  27 1766-1773
• 5 Mont M A, Hungerford D S. Non-traumatic avascular necrosis of the femoral head.  J Bone Joint Surg Am. 1995;  77 459-474
• 6 Cruess R L. Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip.  Clin Orthop Relat Res. 1978;  130 86-93
• 7 Mont M A, Maar D C, Urquhart M W, Lennox D, Hungerford D S. Avascular necrosis of the humeral head treated by core decompression: a retrospective review.  J Bone Joint Surg Br. 1993;  75 785-788
• 8 LaPorte D M, Mont M A, Mohan V, Pierre-Jacques H, Jones L C, Hungerford D S. Osteonecrosis of the humeral head treated by core decompression.  Clin Orthop Relat Res. 1998;  355 254-260
• 9 Hattrup S J, Cofield R H. Osteonecrosis of the humeral head: results of replacement.  J Shoulder Elbow Surg. 2000;  9 177-182
• 10 Parsch D, Lehner B, Loew M. Shoulder arthroplasty in nontraumatic osteonecrosis of the humeral head.  J Shoulder Elbow Surg. 2003;  12 226-230
• 11 Mont M A, Hungerford D S. Non-traumatic avascular necrosis of the femoral head.  J Bone Joint Surg Am. 1995;  77 459-474
• 12 Urbaniak J R, Coogan P G, Gunneson E B, Nunley J A. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: a long-term follow-up study of 103 hips.  J Bone Joint Surg Am. 1995;  77 681-694
• 13 Kawate K, Yajima H, Ohgushi H et al.. Tissue-engineered approach for the treatment of steroid-induced osteonecrosis of the femoral head: transplantation of autologous mesenchymal stem cells cultured with beta-tricalcium phosphate ceramics and free vascularized fibula.  Artif Organs. 2006;  30 960-962
• 14 Jacobs B. Epidemiology of traumatic and nontraumatic osteonecrosis.  Clin Orthop Relat Res. 1978;  130 51-67
• 15 Milner P F, Kraus A P, Sebes J I et al.. Osteonecrosis of the humeral head in sickle cell disease.  Clin Orthop Relat Res. 1993;  289 136-143
• 16 Van Blarcom S T, Czarnecki D J, Fueredi G A, Wenzel M S. Does dysbaric osteonecrosis progress in the absence of further hyperbaric exposure? A 10-year radiologic follow-up of 15 patients.  AJR Am J Roentgenol. 1990;  155 95-97
• 17 Rodrigue S W, Rosenthal D I, Barton N W, Zurakowski D, Mankin H J. Risk factors for osteonecrosis in patients with type I Gaucher's disease.  Clin Orthop Relat Res. 1999;  362 201-207
• 18 Ficat R P. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment.  J Bone Joint Surg Br. 1985;  67 3-9
• 19 Rindell K. Muscle pedicled bone graft in revascularization of aseptic necrosis of the humeral head.  Ann Chir Gynaecol. 1987;  76 283-285