Treatment of Scaphoid Nonunion Using the Free Corticocancellous Lateral Femoral Condyle Bone Flap

Abstract

Without treatment, scaphoid nonunions evolve toward carpal collapse and progressive degenerative changes known as scaphoid nonunion advanced collapse (SNAC). Debridement of devitalized bone followed by reconstruction with either non-vascularized or pedicled bone represents proven methods to achieve bone healing. The presence of significant bone gaps, however, demands vascularized bone transfer to attain healing. Local pedicled flaps from the distal radius although proven useful, provide limited amount of bone substance and rely on retrograde circulation. Vascularized bone flaps from the femoral condyles can provide significant amount of bone and can be harvested both as corticocancellous (with or without cartilage) and corticoperiosteal constructs. Here we present a patient with scaphoid nonunion, where a free lateral femoral condyle corticocancellous flap was successfully used for scaphoid reconstruction. Three months postoperatively, complete scaphoid healing allowed the patient to return to his normal life, pain-free, and with a normal-functioning wrist.