Pseudarthroses du scaphoïde traitées par greffon vascularisé de Kuhlmann : résultats radiographiques et complications

Abstract

During the last few years, several types of vascularized bone grafts have been described for the treatment of scaphoid nonunions reporting rates of union often higher than 90%. The goal of this study was to evaluate the results, complications and failures of Kuhlmann's vascularized bone graft. Thirty patients who had benefited from this graft between 2000 and 2005 were reexamined. The average age was 27 years (15-66 years). Seventeen patients were smokers. There were two cases of proximal pole necrosis. The average follow-up was 28 months (eight to 60 months). Osteosynthesis was carried out in 23 cases using a Herbert screw, in seven times with pins alone. Average immobilization time was six weeks. Twenty-two nonunions healed, that is to say a 73% union rate. Neither of the two cases of proximal pole necrosis cases united. Two articular radius fractures occurred during the harvesting of the graft. Five patients underwent a second intervention after this vascularized bone graft: four proximal row carpectomies and one conventional bone graft. Our union rate is disappointing, particularly compared to nonvascularized bone grafts for which the success rate is usually higher than 80%. This technique has many advantages thanks to its unique volar approach, but its realization requires a learning curve and important complications can occur at the beginning of experiment.