The results of pedicled vascularized bone grafts in the treatment of scaphoid nonunion

Abstract

Objectives: Scaphoid nonunion still creates a big challenge for hand surgeons due to high failure rates after surgery, particularly in proximal pole fractures. The pedicled vascularized bone graft (VBG) is a valuable option to achieve union and good outcomes. This study aimed to analyze the clinical and radiological results of patients who underwent scaphoid fixation with pedicled VBG due to non-union of a scaphoid fracture. Methods: The patients who were operated due to scaphoid non-union and underwent fixation with pedicled VBG between 2017 and 2018 were reviewed retrospectively. The patients were evaluated both preoperatively and postoperatively. The clinical assessments included; the range of motion, grip strength, Mayo wrist score, and visual analogue scale (VAS) pain score. The presence of bony union was evaluated with direct radiographs. Results: Eight patients were included in the final analysis. Four patients who had waist non-union were reconstructed with volar pedicled VBG, while the other four patients with proximal non-union were reconstructed with dorsal 1,2 ICSRA pedicled VBG. The average age was 28.7 and the average follow-up was 12.3 months. The bony union was achieved in 7 patients at average 3.1 months with gain of both range of motion and grip strength. The average VAS pain score was improved from 6.8 to 2. The average Mayo wrist score was improved from 52.2 to 80.4. Conclusion: The application of pedicled VBGs harvested from the distal radius provides good clinical and radiological outcomes in the treatment of scaphoid non-unions.