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Comparative meta-analysis on the various vascularized bone flaps used for the treatment of scaphoid nonunion.

TitleComparative meta-analysis on the various vascularized bone flaps used for the treatment of scaphoid nonunion.
Publication TypeJournal Article
Year of Publication2017
AuthorsDitsios, K., Konstantinidis I., Agas K., & Christodoulou A.
JournalJ Orthop Res
Volume35
Issue5
Pagination1076-1085
Date Published2017 05
ISSN1554-527X
KeywordsFractures, Ununited, Hand Strength, Humans, Range of Motion, Articular, Recovery of Function, Scaphoid Bone, Surgical Flaps, Wrist Injuries
Abstract

We did a meta-analysis of the literature in order to clarify which of the vascularized bone flaps (VBF) used for scaphoid non-union treatment has the best outcome with regard to various parameters. We analyzed 54 articles that present nine different types of VBF. The analysis concerned demographical patient information, radiographic parameters, fracture classification, including the presence or non-presence of avascular necrosis of the scaphoid proximal pole (PP AVN), parameters that have to do with the surgery itself and the postoperative protocol, the healing of the nonunion and functional scores. The meta-analysis showed best healing potential for the femoral graft despite the complexity of the operation. On the other hand, the most commonly used 1,2-ICSRA flap makes the procedure more reproducible but showed worse results. The femoral flap was also among the most successful flaps when used for patients with PP AVN. The consolidation rate, in general, was not affected by the time elapsed between the fracture and the operation but by smoking and the presence of PP AVN. The meta-analysis could not reach many significant statistical conclusions because of either the small number of patients in some flap groups or the heterogeneity and lack of documentation in most of the articles. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1076-1085, 2017.

DOI10.1002/jor.23242
Alternate JournalJ. Orthop. Res.
PubMed ID27018317

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