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Scaphoid pseudarthrosis: bone graft using microsurgery

14 三月, 2016

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Bones non unions due to unfused fractures may result in pseudarthrosis pictures if they are not treated in time. In the upper limb, scaphoid fractures are at risk of becoming scaphoid pseudarthrosis, with the possibility of ending up in a surgical fixation of the wrist, and the corresponding loss of mobility and function, if not addressed appropriately.

In this clinical case the patient, 18 year old, comes to the clinic of Dr. Del Piñal with a scaphoid fracture already operated, which -as the non union persisted after the procedure- has resulted in a situation of pseudarthrosis. Pain and certain function difficulties acted as alarm signals.

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Left side of the image (blue shading), the nonunion of the scaphoid fracture is seen. Despite the size of the defect, no more than 0.8 cm., the impact on the patient is remarkable.

The problem

The scaphoid pseudarthrosis causes pain and functional disturbances in the patient, with the risk of becoming a permanent picture if there is no intervention. The deffect, of no more than 0.8 cm., has a very significant impact however.

The objectives

The goals of the surgical unit of Dr. Del Piñal are fundamentally four: reverse the impaired functional mechanics to avoid an arthritic wrist, eliminate pain, restore mobility of the affected area and minimize the aesthetic impact of the procedure.

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The site is prepared in the damaged area to receive the vascularized graft accurately.

The plan 

Dr. Del Piñal outlines a microsurgical approach based on the realization of a vascularized bone graft taken from the internal face of the patient’s own femur. This fragment will have to return the flow to the damaged area by reconnecting arteries and veins through the application of microsurgical techniques.

In turn, the insertion of a surgical screw helps stabilize the grafted material, facilitating the scaphoid to heal.

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The inner side of the femur acts as donor site of the bone material to be grafted. The knee area is not touched.
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In the image, the fragment of femur on the surgeon’s hand allows to observe both its vascularization and its small size.
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The composition shows the microdots applied in the reconnection of veins and arteries, in a minimally invasive procedure.
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Postoperative image reveals the success of the procedure, the fracture consolidates thanks to the graft (bordered in black) and the insertion into the scaphoid (enclosed in red) of a surgical screw.

The outcome

After 6 hours in the operating room, the result of the procedure is successful. The patient needs 8 weeks of immobilization with plaster, for a total of 3-month recovery period.

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The intervention of the surgical team of Dr. Del Piñal is a success. The patient shows excellent functional recovery, with limited aesthetic impact.