Scaphoid nonunion volar pedicle vascularized graft versus volar peg graft

Abstract

Background Scaphoid fracture nonunion often presents a therapeutic challenge. This is because the vascular supply of the scaphoid renders the proximal pole in many of these fractures avascular. Russe reported the use of an anterior inlay graft and, since then, other techniques of bone grafting have been devised. More recently, vascularized bone grafts for scaphoid nonunion have gained increasing popularity and many methods have been described on the basis of different pedicles. Aim of the study This study performs a comparison of the results of the treatment of scaphoid nonunion fractures using a volar radial vascularized pedicle bone graft and a volar peg graft. Patients and methods In a prospective study, 45 patients with nonunions scaphoid fractures were divided randomly into two equal groups: a group treated using a volar radial vascularized pedicle bone graft and a group treated using a volar bone peg graft technique. Results The final end result was assessed according to the Cooney score scale; in group A (volar peg graft), bone union was achieved in 15 patients (68.20%). There were five excellent, seven good, three fair, and seven poor results. In group B (volar vascularized graft), bone union was achieved in all patients (100%). There were 10 excellent, 10 good, and three fair results. Conclusion A volar vascularized pedicle bone graft is a viable option for the treatment of scaphoid nonunion that leads to rapid union and consolidation of proximal pole scaphoid nonunion, with better both clinical and radiological results.