title: An alternative graft fixation technique for scaphoid nonunions treated with vascular bone grafting.
abstract: OBJECTIVE
  To present our experience with vascularized bone grafting based on the 1,2-intercompartmental supraretinacular artery for the management of established scaphoid nonunion and to investigate the efficacy of graft immobilization with a combination of Kirschner wires and transarticular external fixation.
  
  
  METHODS
  A retrospective chart and radiographic review was conducted for patients with the diagnosis of scaphoid nonunion of the proximal pole or the waist treated with the 1,2-intercompartmental supraretinacular artery-based vascularized graft and fixed with a combination of Kirschner wires and transarticular external fixation between 2007 and 2011.
  
  
  RESULTS
  We observed 23 consecutive patients for a mean of 34 ± 4 months. All patients were males with mean age of 25 ± 5 years. All patients had scaphoid nonunion and associated humpback deformity. The mean duration of nonunion was 7 ± 1 months. All scaphoid nonunions united after the index procedure at a mean of 10 ± 1 weeks. Two patients had avascular necrosis of the proximal pole based on the preoperative magnetic resonance imaging findings. After surgery, deformity correction was achieved in all patients, as recorded by the decrease in the lateral intrascaphoid angle and the increase in the dorsal scaphoid angle. At the last follow-up, no patients reported wrist pain. The mean Disabilities of the Arm, Shoulder, and Hand score improved significantly from 32 ± 12 before the operation to 5 ± 3 at the last postoperative visit. All patients showed statistically significant improvement in the range of motion and the grip strength of the involved wrist.
  
  
  CONCLUSIONS
  The results of this study support the combined use of Kirschner wires and transarticular external fixation for fixation of a 1,2-intercompartmental supraretinacular artery-based vascular bone graft in the treatment of scaphoid nonunions.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece. Electronic address: koroban1960@gmail.com.
authors.forename: Anastasios V
authors.initials: AV
authors.lastname: Korompilias
authors.affiliation: Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Marios G
authors.initials: MG
authors.lastname: Lykissas
authors.affiliation: Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Kostas-Agnantis
authors.affiliation: Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gkiatas
authors.affiliation: Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Alexandros E
authors.initials: AE
authors.lastname: Beris
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D001864:Bone Wires; D015331:Cohort Studies; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods; D019737:Transplants / Q000098:blood supply*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Scaphoid fracture; bone healing; external fixation; scaphoid nonunion; vascularized bone graft