Free bone flap transplantation with descending genicular vessels for treatment of scaphoid nonunion

Abstract

Objective To evaluate the effect of bone flap transplantation with descending genicular vessels for treatment of scaphoid nonunion.Methods From January 2007 to August 2009,6 cases of scaphoid nonunion were treated with free bone flap transplantation with descending genicular vessels.The results of the procedure were assessed in terms of osseous union,pain,grip strength and active motion of the wrist.Postoperatively treatment outcomes were evaluated by the Mayo modified wrist score system based on patients' perception of function,while vascularity of the scaphoid was evaluated by using color Doppler ultrasonography.Results Postoperative follow-up averaged 18 months.Scaphoid union occurred in all cases at an average of 12 weeks (range,11 to 16 weeks).The average pain score for these 6 patients was 1.0 points (range,0 to 2.2points) on the visual analog scale.The postoperative grip strength was 85％ of the contralateral side.The range of motion of the wrist was:flexion-extension ( 115 ± 10)°,radioulnar deviation (54 ± 14)°.An excellent outcome in the wrist function was found in 4 patients,a good outcome in 1 patient,fair in 1 patient.Vascularity of the scaphoid was good as confirmed by color Doppler ultrasonography. Conclusion Transplantation of bone flap with descending genicular vessels is an effective method for the treatment of scaphoid nonunion with avascular necrosis of the proximal fragment or with previously failed conventional bone grafting. Key words: Scaphoid bone;  Fractures,ununited;  Descending genicular vessels