Abstract
Background Vascularized bone grafts have become one of the first treatment options for scaphoid
nonunions and Kienböck's disease. The aim of this study is to review the current body
of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2
intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental
artery] graft, volar radial graft, and free medial femoral condyle graft) in these
pathologies.
Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included
language other than English, studies with no full text available, case reports, letters,
editorials, and review articles. The primary outcomes included consolidation rate
of the grafts and time to union regarding scaphoid nonunion, as well as the clinical
outcomes (pain, grip strength, range of motion), revascularization of the lunate,
and progression of the disease regarding Kienböck's disease.
Results A total of 37 articles were included in the study enrolling 917 patients. Regarding
scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9%
for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft.
In patients with Kienböck's disease, progression of the disease was observed in 13%
of patients, and grip strength and pain were substantially improved whereas range
of motion did not demonstrate statistically significant improvement (p < 0.05).
Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions
demonstrating a high union rate. In patients with Kienböck's disease, vascularized
grafts lead to revascularization of the lunate in most of the cases with concomitant
improvement of the clinical parameters.
Keywords
vascularized bone grafts - 1,2 intercompartmental supraretinacular artery graft -
4+5 extracompartmental artery graft - volar distal radius graft - medial condyle-free
graft
