A vascularized bone graft harvested from the dorsal base of the third metacarpal bone for the treatment of scaphoid nonunion

Abstract

The purpose of this retrospective study was to introduce the use of an alternative vascularized bone graft for treating scaphoid non-union. The vascularized bone graft was harvested from the dorsal base of the third metacarpal bone. From May 2014 to September 2017, 29 patients with scaphoid non-union were treated. Grip and pinch strengths were compared to the contralateral side. The patients rated wrist joint pain on a visual analogue scale. Wrist function was assessed on Mayo Wrist Score. p < 0.05 was considered statistically significant. 18 scaphoids healed at 6 weeks and the other 11 at 16 weeks. Follow-up ranged from 28 to 73 months, for a mean 48 months. At final follow-up, mean wrist flexion had improved from 65° (range, 51°–81°) preoperatively to 72° (range, 61–78°) (p > 0.05), for a contralateral value of 74° (range, 65°–86°). Mean extension had improved from 56° (range, 44°–72°) to 60° (range, 47°–76°) (p > 0.05) for a contralateral value of 66° (range, 52°–80°). Mean wrist pain improved from 4 (range, 3–8) to 2 (range, 0–4) (p < 0.05). Mean pinch strength improved from 6.4 kg (range, 5.2–7.3 kg) to 8.6 kg (6.1–9.9 kg) (p < 0.05). Mayo Wrist Score improved from 49 (range, 10–65) to 92 (range, 70–100) (p < 0.05). Transferring a vascularized bone graft harvested from the base of the third metacarpal bone was an effective alternative for the treatment of scaphoid non-union, achieving bone healing and normal wrist function without significant donor-site morbidity. Type of study/level of evidenceTherapeutic IV.