Artikel
Treatment of scaphoid non-unions by an anterior graft of the 1,2-intercompartmental supraretinacular artery vascularized bone graft
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Autoren
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Camilo Chaves
- Université Paris XI, Le Kremlin-Bicêtre, France
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Ghada Asmar
- Ramsay Generale de Santé - Hôpital privé Paul d’Egine, Champigny sur Marne, France
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Fanny Billac
- Université Paris 5, Paris, France
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Marc-Oliver Falcone
- Ramsay Generale de Santé - Hôpital privé Paul d’Egine, Clinique Internationale du Parc Monceau, Champigny sur Marne, France
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Scaphoid non-union is a frequent complication that affects up to 15% of scaphoid fractures and leads to loss of strength and mobility which burdens the healthcare system directly and indirectly. One of the available treatments is the vascularized bone graft from the distal radius, pedicled on the intercompartmental supraretinacular artery 1-2 (1,2 ICSRA), and grafted on the scaphoid by a dorso-radial approach as described by Zaidemberg. This technique is however limited to the treatment of non-unions of the proximal pole, without significant bone loss or carpal collapse.
This thesis evaluates the feasibility and the functional and radiological outcomes of a palmar graft of the vascularized bone graft pedicled on the 1,2 ICSRA for the treatment of non-unions of the neck, waist, or body of the scaphoid.
Methods: An anatomical study on eleven wrists evaluated the feasibility by measuring the pedicle length and the arc of rotation between the radial donor site and the palmar graft site on the scaphoid.
A monocentric, retrospective, clinical study included patients presenting a non-union of the neck, waist or body of the scaphoid operated between 2011 and 2018. The primary outcome measurements were the union rate and the simplified "disabilities of the arm, shoulder and hand questionnaire "(QuickDASH).
Results and Conclusions: The average length of the pedicle was 20.4 mm (16-26 mm). The arc of rotation of the graft was 122 ° (91-155 °).
Eighteen patients were included with an average follow-up of 33.9 months (6-75 months). The average QuickDASH score was 10.4 (0-45). The union rate of the grafts was 88.9% without any displacement or failure of fixation.
Several vascularized bone grafts have been described for the treatment of scaphoid non-unions but there is no consensus on the best therapeutic choice.
The palmar graft of the vascularized bone graft pedicled on the 1,2 ICSRA is feasible and offers good clinico-radiological results for the treatment of non-unions of the neck, waist or body of the scaphoid. By expanding the classical indications of the vascularised bone graft described by Zaidemberg, this thesis provides new elements for the understanding and treatment of scaphoid non-unions.
