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J Wrist Surg 2024; 13(04): 346-351
DOI: 10.1055/s-0043-1777734
Scientific Article

A Comparison of Rib Osteochondral Graft to Medial Femoral Trochlear Osteocartilaginous Graft for the Salvage of the Fragmented Scaphoid Proximal Pole: A Single-Center Experience with Minimum 2-Year Follow-Up

Stephen Butler
1   Victorian Hand Surgery Associates, Fitzroy, Australia
,
John Galbraith
2   Hand Unit, Dandenong Hospital, Dandenong, Australia
,
Eugene T. H. Ek
2   Hand Unit, Dandenong Hospital, Dandenong, Australia
3   Hand and Wrist Biomechanics Laboratory, O'Brien Institute at St. Vincent's Institute, Melbourne, Australia
,
Anthony Berger
1   Victorian Hand Surgery Associates, Fitzroy, Australia
4   Department Plastic, Reconstructive and Hand Surgery, St.Vincent's Hospital, Fitzroy, Australia
,
David McCombe
1   Victorian Hand Surgery Associates, Fitzroy, Australia
3   Hand and Wrist Biomechanics Laboratory, O'Brien Institute at St. Vincent's Institute, Melbourne, Australia
4   Department Plastic, Reconstructive and Hand Surgery, St.Vincent's Hospital, Fitzroy, Australia
5   Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
,
Stephen K. Tham 
1   Victorian Hand Surgery Associates, Fitzroy, Australia
2   Hand Unit, Dandenong Hospital, Dandenong, Australia
3   Hand and Wrist Biomechanics Laboratory, O'Brien Institute at St. Vincent's Institute, Melbourne, Australia
4   Department Plastic, Reconstructive and Hand Surgery, St.Vincent's Hospital, Fitzroy, Australia
› Author Affiliations Funding The authors acknowledge funding from the Victorian Hand Surgery Associates Research Fund. The research fund did not exert influence over any aspects of the study.
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Abstract

Purpose Fragmented fractures of the proximal pole of the scaphoid that cannot be internally fixed may be salvaged by four-corner arthrodesis or proximal row carpectomy. Replacement of the proximal scaphoid with costal-osteochondral graft (COG) or the medial femoral trochlea (MFT) graft are two alternative solutions for this clinical presentation. The purpose of this study was to compare the clinical and radiographic results of the COG and the MFT graft with a minimum 2-year follow-up from a single centre.

Methods A retrospective study was performed to investigate the outcome of COG and MFT with a minimum 2 year follow up. Demographic data and clinical assessment including wrist range of motion and grip strength measurements and Oxford Knee score were collected. Patients completed the outcome measures of Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a ten-point visual analogue score for pain (VAS). Radiological examination was performed on all wrists at follow-up.

Results The visual analogue score, DASH and PRWE were similar between the two groups. There was radiographic evidence of arthritis between the radial styloid and distal scaphoid in all patients that underwent COG but no evidence in those that underwent MFT graft reconstruction. There were different complications in each group. Thirty percent of patients that underwent MFT reconstruction had persistent knee pain at follow up.

Conclusion Though there are notable differences in the follow-up period, patients undergoing MFT risk developing knee pain, while those undergoing COG risk radiographic progression of wrist arthritis.

Level of Evidence III – Comparative study.

Keywords

scaphoid - proximal pole - costal-osteochondral - rib graft - medial femoral trochlea

Ethical Approval

This study received approval from the institutional ethics review board, St Vincent's Hospital (Melbourne) HREC. Approval number LRR 072/20.


Informed Consent

Informed consent was obtained from all volunteers as per institutional ethics review board protocol.




Publication History

Received: 20 June 2023

Accepted: 21 November 2023

Article published online:
22 December 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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