Treatment of scaphoid nonunion with vascularised  and nonvascularised dorsal bone grafting  from the distal radius.
We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p=0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.
Ribak
Samuel
S
Department of Orthopaedic Surgery, Hospital Nossa Senhora do Pari, São Paulo, Brazil. samuelribak@terra.com.br
Medina
Carlos Eduardo Gonzalez
CE
Mattar
Rames
R
Ulson
Heitor Jose Rizzardo
HJ
Ulson
Heitor Jose Rizzardo
HJ
Etchebehere
Mauricio
M
D000203:Activities of Daily Living; D016025:Bone Transplantation / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D017060:Patient Satisfaction; D019736:Prostheses and Implants; D011884:Radius / Q000098:blood supply / Q000601:surgery / Q000637:transplantation; D016059:Range of Motion, Articular; D020127:Recovery of Function; D021361:Scaphoid Bone / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*