Vascularised bone graft with mini-acutrak ® fixation in scaphoid pseudoarthrosis with proximal pole necrosis

Abstract

Objectives We studied the use of vascularized bone graft (VBG) in combination with a fixation with screw in patients with scaphoid nonunion and avascular proximal poles. Materials and methods Between January 2006 and December 2009, we treated 10 patients with scaphoid nonunion with avascular proximal poles. There were 10 males with nonunion. Their average age was 27 years (range: 18–46 years). The average followup was 18 months (range: 12–43 months). The clinical valuation was the scale of pain (VAS), the range of motion and grip strength. The radiological valuation included radiographies, CT and MRI. We studied the scapholunate angle, the Carpal Height Index by Nattrass et al. and the Mayo Wrist Score. Results The mean preoperative VAS was 4.5 (2–8) and postoperative VAS 1 (0–2). All patients achieved union in an average time of 15 weeks (range: 6–25 weeks). X-rays and CT showed a complete osseous union in all patients. Carpal Height Index was a mean of 1.50 preoperative and 1.58 postoperative. The scapholunate angle was a mean of 52° preoperative and 49° postoperative. Mayo Wrist Score was 53 preoperative and 92 postoperative. Conclusions We have found that the technique which combines VBG with mini acutrak ® screw, is successful in treating scaphoid nonunions with avascular poles. We prefer to use the vessel 1, 2 ICSRA. If this vessel is occasionally absent, other pedicles may be used.