The use of pedicled vascularized bone graft from the dorsum of distal radius for the treatment of scaphoid nonunion

Abstract

Background The use of vascularized bone grafts from the dorsum of the distal radius for the treatment of scaphoid nonunion. Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion with or without avascular necrosis. When preoperative suggestion of avascular necrosis of the proximal pole is confirmed with intraoperative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended. Patients and methods From May 2011 to September 2014, 12 patients with nonunited fracture of the scaphoid were treated with pedicled vascularized bone graft from the dorsum of the distal radius using of the 1,2 intercompartmental supraretinacular artery. Presurgical and postsurgical clinical evaluation included pain, range of motion, and grip strength. Radiographic evaluation included plain radiographs and MRI. The average follow-up period was 26 months (range = 12-40 months). Results At a mean follow-up period of 26 months, all patients clinically improved. Nine patients (75%) reported the absence of any discomfort, two patients (16%) reported slight discomfort after hard work, and only one case (8%) reported pain with light work. The wrist range of motion improved significantly, and the hand grip strength also improved. According to the modified Mayo wrist scoring chart, clinical results were rated as excellent in eight cases, good in three cases, and fair in one case. Radiographically, in eight of the 12 patients, union was achieved within 12 weeks after surgery, and in the other four patients trabecular bridging of the scaphoid fracture was achieved 16 weeks after the procedure. Conclusion 1,2 Intercompartmental supraretinacular artery is superficial to the extensor retinaculum and is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.