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.
Key words
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Article info
Publication history
Published online: November 02, 2022
Accepted:
August 24,
2022
Received:
February 9,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.
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