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Textbook Outcomes in Medial Femoral Condyle versus Medial Femoral Trochlea Free Flap Reconstruction for Scaphoid Nonunion
John R. Dennen, BS, Robert G. DeVito, MD, Malik Walker, BS, Ava G. Chappel, MD, Aaron M. Freilich, MD; Brent R. DeGeorge, M.D., P.h.D.
University of Virginia Health System, Charlottesville, VA
INTRODUCTION: Textbook outcomes in surgery represent a composite metric indicating baseline success. This study aimed to compare rates of a textbook outcome for the operative repair of scaphoid nonunion using medial femoral condyle (MFC) versus medial femoral trochlea (MFT) vascularized bone flaps.
METHODS: A retrospective review of cases from 2017 to 2024 at a single institution was performed after IRB approval. A textbook outcome (TO) was defined as meeting the following criteria: no flap loss, no intraoperative complications, a length of stay of less than two nights, radiographic union at three months, return to baseline hand and lower extremity activities at final follow-up, no infections requiring intravenous antibiotics, no systemic complications, and no surgical complications requiring reoperation. Fisher's exact tests were used to assess correlations between surgery type (MFC versus MFT) with a textbook outcome and specific criteria.
RESULTS: 38 patients met inclusion criteria, with 27 (71.1%) achieving a TO. There was no significant difference of TO rates among patients who underwent a MFC flap versus MFT (p>0.05) Return to pain-free upper extremity functions was similar between MFC and MFT flaps (p>0.05) and the rate of return to pain-free baseline lower extremity activities was similar between MFC and MFT cohorts (p>0.05). Notably, in MFT flaps there was a higher rate of TOs in patients with greater than 12 months time between injury and surgery (p <0.01).
CONCLUSIONS: This study found no significant difference in rates of TOs with utilization of MFC or MFT flap for scaphoid non-union. Notably, the functional lower extremity outcomes were similar between cohorts. Further studies with larger sample sizes may provide deeper insights into factors affecting textbook outcomes in scaphoid nonunion repair using MFC/MFT flaps.
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