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Vascularized Versus Non-Vascularized Bone Graft For Scaphoid Nonunion: Meta-Analysis Of Randomized Controlled Trials And Comparative Studies
Yuki Fujihara, MD, PhD1; Michiro Yamamoto, MD, PhD2; Satoki Hidaka, MD3; Hitoshi Hirata, MD, PhD2
1Department of Orthopedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan; 2Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Nagoya Ekisaikai Hospital, Nagoya, Japan

Introduction: Numerous studies have investigated surgical techniques for vascularized bone graft (VBG) for scaphoid nonunion; however, their efficacies remain unclear. Thus, to estimate the union rate of VBG for scaphoid nonunion, we performed a meta-analysis of randomized controlled trials (RCTs) and comparative studies.
Materials & Methods: A systematic search was conducted using PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials. The search formula was as follows: ((scaphoid nonunion) OR (scaphoid pseudarthrosis)) AND (bone graft). Only RCTs were used in the primary analysis, and comparative studies, including RCTs, in the secondary analysis. The primary outcome was nonunion rate. We compared the outcome between VBG and non-vascularized bone graft (NVBG), pedicled VBG and NVBG, and free VBG and NVBG.
Results: We included a total of four RCTs (263 patients) and 12 observational studies (1411 patients) in this study. (Figure 1) In the meta-analyses of both RCTs only and RCTs and other comparative studies, no significant difference in nonunion rate was found between VBG and NVBG (summary odds ratio [OR], 0.54; 95% confidence interval [CI], 0.191.52 and summary OR, 0.71; 95% CI, 0.451.12), respectively.(Figure 2,3) The nonunion rates of pedicled VBG, free VBG, and NVBG were 15.0%, 10.2%, and 17.8%, respectively, and no significant difference was found.
Conclusions: Our results indicated that the postoperative union rate in NVBG is non-inferior to that in VBG; thus, NVBG could be the first choice of treatment for scaphoid nonunion.



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