Outcomes of Dorsal Capsule-Based Vascularized Radius Grafting Without a Radius Styloidectomy For The Treatment of Stage 1 Scaphoid Non-union Advanced Collapse

Abstract

Objectives: We report the clinical and radiological outcomes of patients with stage 1 scaphoid non-union advanced collapse (SNAC) treated via placement of a dorsal capsule-based, vascularized, distal radius graft in the absence of radial styloidectomy. Methods: This retrospective study included 15 patients (13 men, 2 women). Radial styloidectomy was not performed in any patient. Radiological assessment was conducted using the scapholunate angle, as well as the original and revised carpal height ratios. The short version of the disabilities of the arm, shoulder, and hand (QDASH) score and the modified Mayo wrist score (MMWS) were used for functional assessment; Pain was rated using a visual analogue scale (VAS). At the last follow-up visit, range of motion, grip strength and key pinch strength were measured on both affected and unaffected sides. Results: The mean patient age was 32 (+/-10.4) years; the mean follow-up time was 23.2 (+/-6.8) months. All patients achieved complete bony union. No complications were observed. Although significant decreases in wrist flexion and extension were observed on the affected side, compared with the unaffected side, there were no significant differences in terms of radial or ulnar deviation. Both the MMWS and QDASH scores improved postoperatively, whereas the mean VAS pain score decreased. At the final follow-up, there was no decrease in mean carpal ratios, but the mean scapholunate angle had decreased. Conclusion: Dorsal capsule-based, vascularized, distal radius grafting without a radial styloidectomy is reproducible and reliable. The functional and radiological results are satisfactory for patients with stage 1 SNAC.