title: Vascularized versus non-vascularized bone grafts in the treatment of scaphoid non-union.
abstract: Conventional non-vascularized bone grafts as well as vascularized bone grafts are used to treat scaphoid non-union (SN). Due to limited available studies, the field of application using both grafts for SN still remains controversial. The aim of this study was to evaluate a treatment algorithm for the use of both vascularized versus non-vascularized bone grafts based on clinical outcomes and quality of life (QoL) to improve the level of evidence.
  
  
  
  Based on a retrospective cohort study, including 28 patients with vascularized and 45 patients with conventional bone grafts, functional parameters, radiological outcome, Mayo-wrist-score, and QoL by SF-36 were applied to statistically compare the outcome of these two techniques.
  
  
  
  Time between last procedure or trauma and study group scaphoid reconstruction was almost double in the vascularized bone grafting group. Comparable union rates were achieved with vascularized as well as non-vascularized bone grafts. Significant differences were observed between both groups for grip strength and radial-ulnar active range of motion. Further functional outcomes, radiological outcomes as well as QoL were found similar for both techniques in patients with surgical union.
  
  
  
  In order to achieve comparable and appropriate treatment results, vascularized bone grafts are recommended for patients with delayed treatment, impaired scaphoid vascularity, and revision surgery. Even in preselected, complex cases, the results are comparable to conventional grafts, which are the basis for further patient education and approve the powerful role of surgical angiogenesis of vascularized bone grafts.
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hirche
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.|2 Department of Plastic and Reconstructive Surgery, Union Hospital, Huazhong University of Science and Technology, Hubei, China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Xiong
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heffinger
authors.affiliation: 3 Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Münzberg
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fischer
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.affiliation: 1 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kremer
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D005260:Female; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult
keywords: bone graft; functional outcome; non-union; non-vascularized; quality of life; scaphoid; therapeutic algorithm; vascularized