Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting.
OBJECTIVE
To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments.


METHODS
We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated.


RESULTS
Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery.


CONCLUSIONS
Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment.
Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Korea; Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea; Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea; Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea; Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Tae Kang
TK
Lim
Hyo Kon
HK
Kim
Kyoung Hwan
KH
Koh
Hyun Il
HI
Lee
Sung Jong
SJ
Woo
Min Jong
MJ
Park
D000328:Adult; D001863:Bone Screws; D001864:Bone Wires; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011884:Radius / Q000637:transplantation*; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome
Avascular necrosis; bone grafting; nonunion; scaphoid; vascularized