gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Medial femoral condyle to reconstruct the scaphoid: Did we improve in 8 years of experience? Comparison of our first and last 20 cases

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  • presenting/speaker Christian Kindler - Schoen Klinik Muenchen-Harlaching, München, Germany
  • Moritz Schoeneich - Schoen Klinik Muenchen-Harlaching, München, Germany
  • Bernhard Lukas - Schoen Klinik Muenchen-Harlaching, München, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1701

doi: 10.3205/19ifssh0465, urn:nbn:de:0183-19ifssh04655

Published: February 6, 2020

© 2020 Kindler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Since 2009 we are using the technique of reconstruction of the scaphoid bone with a vascularized bone graft of the medial femoral condyle. The aim of this study was to compare the results of the first 20 (n1) and the last 20 (n2) cases. We wanted to figure out, if results of the last ones are better than the first ones, in detail if we improved over the years

Methods: In our prospective study of scaphoid non-union the patients numbers 1-20 and 94-113 were selected. We compared the results concerning healing rate, complication rate, revision surgeries, donor side morbidity, pain, range of motion, grip strength, krimmer score and surgery time. All surgeons (3) were interviewed to emphasize their tips and tricks and experience.

Results and Conclusions: We could not find any statistic differences in healing rate, range of motion, grip strength, pain reduction and krimmer score. Complication rate was significant lower in the second group (n1=5 versus n2=0), also number of unplanned revision surgery (n1=8 versus n2=1). Donor site morbidity is equal in both groups, only the amount of sensibility disorder was reduced in the second group (n1=13, n2=8). Mean surgery time was 3:22 hours in the first group and 2:44 hours in the second group.

As tips and tricks we revealed:

  • take the most possible distal donor site at the femur,
  • reduce the transplant size by maintaining the periosteum
  • more resection of scaphoid and a bigger transplant makes surgery easier,
  • dorsal and volar approach for osteochondral transplants ist the securest option to receive an accurate proximal pol reconstruction,
  • use of linscheid wire/maneuver,
  • use two different incisions (one for scaphoid, one for the anastomosis).

In our institution we invented this procedure about 8 years ago and we could optimize the surgery technique, to minimize surgery time, complication rate and rate of revision surgery. One must take care of the infrapatellar nerve, but still nerve disorders are common. Data of patient's outcome did not significantly improve over the years, but this also relies to the small number of patients and divergent data. Healing rate stays at a high level of more than 85% in both groups.