Revision surgery after vascularized or non-vascularized scaphoid nonunion repair: A national population study

We aimed (1) to discover the prevalence of vascularized bone grafting in the treatment of scaphoid nonunion and (2) to compare healing using vascularized bone grafting versus standard non-vascularized techniques. Secondarily, we sought to compare resource utilization between procedures and identify...

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Bibliographic Details
Published in:Injury 2020-03, Vol.51 (3), p.656-662
Main Authors: Ross, Phillip R., Lan, Wen-Ching, Chen, Jung-Sheng, Kuo, Chang-Fu, Chung, Kevin C.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Bone Transplantation - methods
Bone Transplantation - statistics & numerical data
Child
Child, Preschool
Databases, Factual
Female
Fractures, Bone - surgery
Fractures, Ununited - surgery
Humans
Infant
Infant, Newborn
Logistic Models
Male
Middle Aged
ORIF
Range of Motion, Articular
Reoperation - statistics & numerical data
Retrospective Studies
Scaphoid Bone - injuries
Scaphoid Bone - surgery
Scaphoid fracture
Scaphoid nonunion
Taiwan
Vascularized bone graft
Young Adult
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Summary:We aimed (1) to discover the prevalence of vascularized bone grafting in the treatment of scaphoid nonunion and (2) to compare healing using vascularized bone grafting versus standard non-vascularized techniques. Secondarily, we sought to compare resource utilization between procedures and identify factors that may be associated with nonunion repair failure. We hypothesized that, despite being less common, vascularized bone grafts have greater success than non-vascularized bone grafting surgeries. We performed a large population analysis using the Truven MarketScan databases to identify patients from 2009 to 2017 with a diagnosis of a scaphoid nonunion undergoing repair surgery with and without the insertion of a pedicled or free vascularized bone graft. We defined any subsequent scaphoid or wrist surgery within 12 months after surgery as surgery failure. We compared success rates and post-operative resource utilization using Chi-squared tests. Of 4177 eligible patients, 358 underwent nonunion repair with vascularized bone graft and 3819 patients received non-vascularized bone grafting. The failure rate requiring revision surgery was 5.0% in vascularized repair, versus 6.1% for non-vascularized surgery. Age and comorbidities did not affect bone graft type. Areas with higher median household incomes had more vascularized repairs. Vascularized bone graft patients received significantly more therapy and imaging after surgery. Most scaphoid nonunion repairs are performed without vascularize bone grafting. Typical nonunions may not justify the increased time and technical demands of vascularized bone grafting, and traditional repair should remain first line treatment for scaphoid nonunions without additional risk factors. Further studies to elucidate which fractures benefit most from vascularized grafting are needed.
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2020.01.035