Vascularized distal radius graft of 1, 2 intercompartmental supraretinacular artery for scaphoid nonunion

Abstract

Objective To study the techniques and outcomes of using a retrograde pedicled vascularized radius bone flap based on the 1st, 2nd intercompartmental supraretinacular artery (1, 2ICSRA) for scaphoid nonunion through dorsal and palmar approaches. Methods Between March 2013 and April 2015, 16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches. There were 14 males and 2 females with an average age of 29.1 years (range, 19-51 years). The location of lesion was 6 cases on the left and 10 cases on the right. 5 cases were treated with plaster fixation. 11 cases weren’t treated after wrists injured. The preoperative time was 6-26 months, with an average of 16.5 months. The operation was completed within one incision. The bone flaps based on 1, 2ICSRA were taken through dorsal approach. The broken ends of the scaphoid fracture were cleaned, and the deformity was corrected with bone grafting and internal fixation through palmar approach. Time of fracture union and wrist pain resolution was evaluated. Wrist motion and grip strength were measured and compared. The result of the latest follow-up was used as the criterion for efficacy evaluation. The wrist pain was evaluated using visual analogue scale (VAS) and the postoperative wrist function based on the modified Mayo wrist score was recorded. Results Post-operative follow up ranged from 6-19 months, with an average of 11 months. Bone union was achieved in all the cases, so the healing rate was 100%. 7 cases were healed in 11 weeks. 5 cases were healed in 13 weeks. 3 cases were healed in 15 weeks. 1 case was healed in 17 weeks. The average healing time was 12.5 weeks. The humpback deformity of Scaphoid and DISI of 7 cases were corrected. The bending of wrist could reach 60.2°±3.2°, and the elongation could reach 51.3°± 3.5°. The radial deviation of wrist could reach 13.6°±1.42°, and ulnar deviation could reach 24.4°±1.8°. The range of grip strength was 29-64 kg, with an average of 45 kg. The 16 patients returned to normal work. The pain after wrist movement of 14 cases was completely disappeared, and the VAS was 0. Two cases felt slight pain when wrist was overworked, and the VAS were 0.9 and 1.2. The wrist joint function of patients recovered well. The modified Mayo score was 69-99, with an average of 90.75. The functional results were 12 excellent, 2 good, and 2 fair, and the excellent and good rate was 87.5% (14/16) . No complications such as infection, failure of screws, orthopaedic arthritis or scaphoid necrosis were found during the follow-up period. Conclusion The technique of 1, 2 ICSRA pedicled bone graft and palmar bone grafting for nonunion of scaphoid can provide convenience for us to deal with the broken ends of the scaphoid fracture, correct the malformation and graft bone through dorsal and palmar approaches. This method can protect the blood supply of the scaphoid, and promote scaphoid union. Key words: Scaphoid bone; Fractures, ununited; Bone transplantation