The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions.
OBJECTIVE
Over the past decade vascularized bone grafts that use a 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) pedicle have gained popularity in the treatment of scaphoid nonunions. The purpose of this study was to evaluate critically the outcome, complications, and failures of 1,2-ICSRA-based vascularized bone grafting at our institution to understand better the appropriate indications, methods, and possible contraindications.


METHODS
From January 1994 through July 2003, 50 scaphoid nonunions in 49 patients were treated with 1,2-ICSRA-based vascularized bone grafts. A retrospective review of the clinical and radiographic information was performed. Two patients were lost to follow-up study. Nine female and 38 male patients averaging 24 years of age were followed-up for an average of 7.8 months.


RESULTS
Thirty-four scaphoid nonunions went on to union at an average of 15.6 weeks after surgery. Complications occurred in 8 patients and consisted of graft extrusion, superficial infection, deep infection, and failure of fixation. Univariate risk factors for failure included older age, proximal pole avascular necrosis, preoperative humpback deformity, nonscrew fixation, tobacco use, and female gender.


CONCLUSIONS
Although previous researchers have concluded that vascularized bone grafts based on the 1,2-ICSRA are efficacious in the treatment of scaphoid nonunions, we determined that a successful outcome is not universal and depends on careful patient and fracture selection and appropriate surgical techniques.


METHODS
Therapeutic, Level IV.
Chang
Michael A
MA
Department of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Bishop
Allen T
AT
Moran
Steven L
SL
Shin
Alexander Y
AY
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications; D011859:Radiography; D011884:Radius / Q000098:blood supply* / Q000637:transplantation*; D012189:Retrospective Studies; D012307:Risk Factors; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome