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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Proximal scaphoid costo-osteochondral replacement arthroplasty.J Hand Surg Br. 1998; 23: 201-208
- Costo-osteochondral graft (rib graft) reconstruction of the irreparable proximal scaphoid.J Hand Surg Eur Vol. 2020; 45: 693-699
- Rib cartilage graft for posttraumatic or degenerative arthritis at wrist level: 10-year results.J Wrist Surg. 2013; 2: 234-238
- Proximal scaphoid rib graft arthroplasty.J Bone Joint Surg Br. 2007; 89: 196-201
- The use of the proximal hamate as an autograft for proximal pole scaphoid fractures: clinical outcomes and biomechanical implications.Hand Clin. 2019; 35: 287-294
- Proximal scaphoid pole reconstruction utilizing ipsilateral proximal hamate autograft.Hand (N Y). 2016; 11: 495-499
- An anthropometric assessment of the proximal hamate autograft for scaphoid proximal pole reconstruction.J Hand Surg Am. 2019; 44: 60.e1-60.e8
- Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions.J Hand Surg Am. 2013; 38: 690-700
- Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications.J Reconstr Microsurg. 2014; 30: 483-490
- The use of osteochondral flaps in the treatment of carpal disorders.J Hand Surg Eur Vol. 2018; 43: 48-56
- Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery.J Bone Joint Surg Am. 2018; 100: 1379-1386
- Scaphoid overstuffing: the effects of the dimensions of scaphoid reconstruction on scapholunate alignment.J Hand Surg Am. 2013; 38: 2419-2425
- Free composite medial femoral trochlea osteochondral cutaneous flap for wrist scaphoid and lunate cartilage lesions: advantages of a skin paddle.Hand Surg Rehabil. 2019; 38: 262-267
- Outcomes of the medial femoral trochlea osteochondral free flap for proximal scaphoid reconstruction.J Hand Surg Am. 2020; 45: 317-326
- Medial femoral trochlea osteochondral flap: applications for scaphoid and lunate reconstruction.Clin Plast Surg. 2020; 47: 491-499
- Medial femoral condyle flap.Plast Reconstr Surg Glob Open. 2016; 4: e834
- Medial femoral trochlea osteochondral flap: applications for scaphoid and lunate reconstruction.Clin Plast Surg. 2017; 44: 257-265
- Lateral femoral condyle flap: an alternative source of vascularized bone from the distal femur.J Hand Surg Am. 2015; 40: 1972-1980
- Anatomy of the vascularized lateral femoral condyle flap.Plast Reconstr Surg. 2016; 137: 1024e-1032e
- Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: implications for surgical dissection.J Plast Reconstr Aesthet Surg. 2018; 71: 33-43
- Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery.Arch Orthop Trauma Surg. 2018; 138: 1395-1405
- The free vascularized lateral femoral trochlea osteochondral graft: a reliable alternative for Stage III Kienböck's disease.J Hand Surg Eur Vol. 2021; 46: 1032-1041
- Nonvascularized cartilage grafts versus vascularized cartilage flaps: comparison of cartilage quality 6 months after transfer.J Hand Surg Am. 2018; 43: 188.e1-188.e8
- Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives.Surg Radiol Anat. 2010; 32: 817-825
- The EWAS classification of scapholunate tears: an anatomical arthroscopic study.J Wrist Surg. 2013; 2: 105-109
- Knee donor site morbidity following harvest of medial femoral trochlea osteochondral flaps for carpal reconstruction.J Hand Surg Am. 2016; 41: 610-614
- Donor site morbidity after the harvest of microvascular flaps from the medial and lateral femoral condyle region: Objective, radiologic, and patient-reported outcome of a multi-center trial.J Plast Reconstr Aesthet Surg. 2022; 75: 160-172
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.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
