title: Vascularized bone grafts for the treatment of carpal bone pathology.
abstract: Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.
authors.affiliation: Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Derby
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Murray
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905 USA.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
authors.affiliation: Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA.
authors.forename: Reuben A
authors.initials: RA
authors.lastname: Bueno
authors.affiliation: Institut de la Main, 6 Square Jouvenet, 75016 Paris, France.
authors.forename: Christophe L
authors.initials: CL
authors.lastname: Mathoulin
authors.affiliation: Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Ade
authors.affiliation: Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Neumeister
keywords: Kienböck’s; Preiser’s; Scaphoid nonunions; VBG’s; Vascular bone grafts