Scaphoid fracture nonunion treated with pronator quadratus pedicled vascularized bone graft and headless compression screw.

Abstract

The purpose of our retrospective study was to evaluate the outcomes of scaphoid fracture nonunion treated with a pronator quadratus pedicled vascularized bone graft and a headless compression screw with regard to early wrist and thumb mobilization. From January 2008 to June 2011, 27 patients (20 men and 7 women; mean age, 24 years; age range, 15-32 years) with scaphoid fracture nonunion were treated with a pronator quadratus pedicled vascularized bone graft and a headless compression screw, and who met our inclusion criteria, including symptomatic scaphoid waist fracture nonunion with or without compromised vascularity and carpal instability. We evaluated radiologic assessment (correction of carpal instability and union rate). And, overall clinical results were also graded using the wrist range of motion, the modified Mayo wrist score, and disabilities of the arm, shoulder and hand score. All patients achieved bony union in a mean of 11.5 weeks (range, 8-18 weeks). The mean radiolunate and scapholunate angles improved from -12.3 degrees (range, -38.0 to 4.5 degrees) and 62.8 degrees (range, 50.0-72.5 degrees) preoperatively to -1.4 degrees (range, -14.5 to 6.5 degrees) and 48.5 degrees (range, 40.5-63.5 degrees) at the follow-up. The final average range of motion was as follows: wrist flexion, 73 degrees (range, 65-85 degrees); extension, 69 degrees (range, 60-80 degrees); ulnar deviation, 36 degrees (range, 15-50 degrees); and radial deviation, 22 degrees (range, 10-35 degrees). The average postoperative modified Mayo wrist score and disabilities of the arm, shoulder and hand score were 92 points (range, 78-100 points) and 11 points (range, 0-32 points), respectively. Our results suggest that a pronator quadratus pedicled vascularized bone graft and internal fixation with a headless compression screw can yield satisfactory functional and radiographic outcomes in the treatment of scaphoid fracture nonunion.