gms | German Medical Science

Objectives/Interrogation: We present the midterm outcome of patients that were treated for an irreparable proximal pole fracture of the scaphoid with a costo-osteochondral graft (rib graft).

The surgical technique itself as well as our rational for the use of this technique are outlined.

Methods: A prospective non-randomised series of 30 consecutive patients with irreparable proximal pole of scaphoid fractures were treated with a rib graft reconstruction. The average follow-up was 25 months. All patients were male with an average age of 25 years.

Subjective outcome measures are Patient Rated Wrist Evaluate (PRWE) and Disability ARM Shoulder Hand (DASH) scores, objective outcomes include clinical range of motion and grip strength.

Post operative x rays were assessed for union and carpal alignment.

Complications are reported.

Results and Conclusions: We noted a statistically significant and clinically relevant improvement of the PRWE from 42 to 23 and of the DASH score from 33 to 16.

The grip strength, measured as percentage of strength of the uninjured arm, improved significantly from 63 to 84%. The average postoperative range of motion arc for flexion/extension was 114 degrees.

Radiologically we noted union of the graft in all but one patient. The scapholunate gap, created by the chondral portion of the graft was maintained in all patients. The capitolunate angle, as marker for carpal alignment, was 82 degrees (range 75-90).

There were no donor site complications noted, i.e. no pneumothorax after rib harvest. One patient needed revision to a four corner fusion for persistent pain due to poor graft quality.

In conclusion we found the cost-osteochondral graft reconstruction a reliable solution for an otherwise difficult problem. Standard salvage procedures remain an option for the patients in the future.