Management of scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone grafts.
BACKGROUND
Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion or avascular necrosis. When pre-operative suggestion of avascular necrosis of the proximal pole is confirmed by intra-operative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended.


METHODS
Five patients with nonunion of scaphoid fractures associated with avascular necrosis based on results of radiography and further confirmed by magnetic resonance images and intra-operative findings were operatively managed with 1, 2 intercompartmental supraretinacular arterial (1, 2 ICSRA) vascularized bone graft combined with supplemental cancellous bone grafts from the radius. Follow-up periods were at least 18 months. The functional outcomes and radiographs were analyzed.


RESULTS
In four of the five patients, the nonunion sites united within 4 months after surgery. The other patient had a superficial pin tract infection and bone healing was complete 6 months after the operation. The functional results were good in all five patients.


CONCLUSIONS
1, 2 ICSRA is superficial to the retinaculum and runs directly into the bony tubercle. It 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.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Tsung-Ting
TT
Tsai
En-Kai
EK
Chao
Yuan-Kun
YK
Tu
Alvin Chao-Yu
AC
Chen
Mel Shiuann-Sheng
MS
Lee
Steve Wen-Neng
SW
Ueng
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery*; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery*