Scaphoid nonunion treated with vascular bone grafts pedicled on the dorsal supra-retinacular artery of the distal radius.
BACKGROUND
Nonunion and avascular necrosis (AVN) are frequent complications of scaphoid fractures. We describe the operative technique and long-term results of treatment with pedicle vascularized bone grafts (VBGs) of the distal radius in patients with scaphoid fractures in whom nonunion and AVN developed.


METHODS
During a 4-year period (1997-2000), VBGs pedicled on either the first and second or second and third compartments of the supraretinacular artery of the distal radius were in our hospital used to treat 11 patients with symptomatic scaphoid nonunion involving AVN of the proximal fragment (one with perilunate transscaphoid fracture dislocation and 10 with displaced scaphoid fractures with nonunion). Nine of these 11 patients received fixation with divergent K-wires fixation and two received Herbert screws fixation.


RESULTS
Osseous union was achieved in all 11 patients treated with VBGs within an average period of 13 weeks. Functional results of treatment, which were measured using the modified Mayo Wrist Score, were encouraging in all patients in this series (four excellent, six good, and one fair). The deformity of ununited scaphoid was well corrected.


CONCLUSIONS
The index study suggests that this treatment can be used not only to revascularize necrotic scaphoid, but also to correct humpback deformity and the resulting carpal instability.
Chen
Alvin Chao-Yu
AC
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital & Chang Gung University, Taoyuan, Taiwan. alvinchen@adm.cgmh.org.tw
Chao
En-Kai
EK
Tu
Yuan-Kun
YK
Ueng
Steve Wen-Neng
SW
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000473:pathology / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D021361:Scaphoid Bone / Q000293:injuries* / Q000473:pathology / Q000601:surgery