title: Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse.
abstract: OBJECTIVE
  To determine the outcome of an alternative treatment for wrists with stages I to III scaphoid nonunion advanced collapse using a closing-wedge osteotomy of the distal radius and a vascularized bone graft for scaphoid reconstruction.
  
  
  METHODS
  Twelve patients with scaphoid nonunion advanced collapse (stage I, 3; stage II, 7; stage III, 2) treated with a vascularized bone graft interposition for the scaphoid and a closing-wedge osteotomy for the distal radius were retrospectively reviewed. Data were obtained and analyzed from the radiographs, and we assessed the pre- and postoperative range of motion, grip strength, visual analog scale pain score, as well as the Mayo and Disabilities of the Arm, Shoulder, and Hand (DASH) functional scores.
  
  
  RESULTS
  Follow-up ranged from 2 to 11 years. All scaphoid nonunions united after an average of 9 weeks, and all osteotomies united after an average of 8 weeks. Although there was radiographic progression of the scaphoid nonunion advanced collapse stage in 5 of 12 cases, there was major improvement in visual analog scale pain score (from 6.1 to 0.8) and in both Mayo (from 64 to 85) and DASH (from 40 to 9) functional scores. The range of motion remained unchanged, and grip strength trended toward minor improvement. The carpal height was preserved, and the dorsal intercalated segmental instability was corrected.
  
  
  CONCLUSIONS
  Scaphoid reconstruction with vascularized bone graft combined with closing-wedge distal radius osteotomy preserved wrist function for scaphoid nonunion advanced collapse. The method offers pain relief and does not compromise wrist motion or grip strength.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Koutalos
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece.
authors.forename: Loukia
authors.initials: L
authors.lastname: Papatheodorou
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece.
authors.forename: Sokratis
authors.initials: S
authors.lastname: Varitimidis
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kontogeorgakos
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessalia, Larissa, Greece. Electronic address: dailiana@med.uth.gr.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Dailiana
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D011884:Radius / Q000098:blood supply / Q000637:transplantation*; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome
keywords: Distal radius osteotomy; SNAC wrist; radiocarpal arthritis; scaphoid nonunion; vascularized bone graft