Autologous iliac bone flap graft with cross Kirschner wire fixation for treatment of scaphoid waist fracture nonunion in young adults

Abstract

Objective To explore the autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation in the treatment of scaphoid waist fracture nonunion in young adults. Methods From January 2010 and August 2015, 18 cases of scaphoid waist fracture nonunion were treated in our department. According to preoperative MRI evaluation, ischemic necrosis of proximal or distal pole scaphoid was not seen. The incision was made at dorsal radial wrist. Autologous iliac flap grafting and packing combined with cross Kirschner wire and splint fixation were conducted after cleaning up the dead bone of scaphoid nonunion. Postoperatively, injured limb was continuously fixed by splint for 6 weeks. Removal of Kirschner wire was conducted when fracture line blurred showed by wrist X-ray photograph. The patients were guided to gradually strengthen the wrist joint function exercise. Results Postoperative follow-up ranged from 6 to 24 months, with an average of 13 months. All the cases of scaphoid waist fracture nonunion were healed with 2 cases of delayed union. No scaphoid necrosis occurred. Wrist joint stability was achieved. Wrist joint pain disappeared in 16 cases. Two cases still had slightly pain and significantly alleviated compared with preoperative condition. Postoperatively the angle of wrist extension was 38° to 60° (average, 52°), of wrist flexion 36° to 60° (average, 48°). The wrist range of motion obviously improved. Hand grip strength was 42.5 to 55.5 kg (average, 50.6 kg) for male patients and 28.5 to 35.4 kg (average, 32.6 kg) for female patients. Grip strength increased postoperatively and the patients returned to original work. Conclusion Autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation is a good method for treating scaphoid waist fracture nonunion in young adults, because of the simple technique, minor local injuries of wrist, and satisfactory curative effects. Key words: Scaphoid bone; Fractures,bone; Nonunion; Iliac bone flap