Abstract
Introduction: Although vascularized bone grafting (VBG) using 1, 2 intercompartmental supraretinacular artery (1, 2 ICSRA) is effective for scaphoid nonunion, dorsal intercalated segment instability (DISI) deformity persists even after correction of humpback deformity (HD). The purpose of this retrospective study was to evaluate the correction of HD and DISI deformity after 1, 2 ICSRA VBG for scaphoid nonunion. Methods: We treated 18 patients (mean age: 25.8, 16 males and 2 females) with scaphoid nonunion using a 1, 2-ICSRA VBG between January 2010 and December 2018. The average time from injury to surgery was 20.0 (3–120) months. The nonunions were located at the waist in all patients. The correction of HD and DISI deformity was investigated on the preoperative images and images at the last examination. Results: In all patients, the correction of HD was positively correlated with that of DISI deformity. Moreover, we focused on the time from injury to surgery and evaluated changes in HD and DISI deformity according to the time to surgery. As a result, changes in HD and DISI deformity were positively correlated in patients with a shorter time to surgery but were not correlated when the time to surgery exceeded 5 months. Conclusions: These results suggest that DISI deformity can be corrected by correcting HD when the time from injury to surgery is short, but that correction is difficult if the time to surgery is prolonged.
Highlights
Vascularized pedicled radial grafting for scaphoid nonunion reported in 1991 by Zaidemberg (Z procedure) is autologous bone grafting using the ascending irrigating branch of the radius, i.e., 1, 2 intercompartmental supraretinacular artery (1, 2 ICSRA) as the feeding vessel [1]
In patients judged by preoperative imaging to have relatively severe dorsal intercalated segment instability (DISI) deformity, the radius and lunate bone were temporarily fixed for intraoperative correction of DISI deformity by inserting a Kirschner wire from the dorsal side of the radius toward the lunate bone while correcting the radiolunate (RL) angle to 0° by volarly flexing the wrist, and the graft was placed in this condition
To correct humpback deformity (HD) associated with scaphoid nonunion, it is necessary to graft a sufficient amount of bone as a support on the volar side [11]
Summary
Vascularized pedicled radial grafting for scaphoid nonunion reported in 1991 by Zaidemberg (Z procedure) is autologous bone grafting using the ascending irrigating branch of the radius, i.e., 1, 2 intercompartmental supraretinacular artery (1, 2 ICSRA) as the feeding vessel [1]. Vascularized bone grafting (VBG) is effective for the treatment of scaphoid nonunion, in refractory cases, such as those accompanied by avascular necrosis (AVN), those with a history of surgery, those with a long period after injury, and those of the proximal third of the scaphoid [2]. The proximal fragment flexes dorsally with the lunate bone to cause DISI deformity [7, 8], and persistence of DISI deformity is reported to be a factor of poor clinical prognosis [9, 10]. Correction of HD and DISI deformity is important along with bone union for improving the clinical outcome of nonunion and preventing scaphoid nonunion advanced collapse (SNAC) wrist. Kim et al reported autologous iliac bone grafts for scaphoid nonunion showed a significant correlation
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