Article
Treatment of Proximal Pole Scaphoid Nonunion with Capsular-Based Vascularized Distal Radius Graft
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Authors
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Loukia Papatheodorou
- University of Pittsburgh Medical School, Orthopaedic Specialists - UPMC, Pittsburgh, United States
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Dean Sotereanos
- University of Pittsburgh Medical School, Orthopaedic Specialists - UPMC, Pittsburgh, United States
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Treatment of proximal pole scaphoid nonunion with avascular necrosis is a challenging issue. We retrospectively reviewed the results of 89 patients with proximal pole scaphoid nonunion, 58 with avascular necrosis, treated with a capsular-based vascularized distal radius graft.
Methods: Seventy-one male and eighteen female patients with symptomatic nonunion at the proximal pole of the scaphoid were included in this study. No patient had a humpback deformity. The mean patient age was 28 years (range, 19-44). In all patients, the vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a capsular flap of the dorsal wrist capsule. The graft was vascularized by the artery of the fourth extensor compartment. After fixation of the scaphoid with a small cannulated screw, the graft was inserted press-fit into a dorsal trough across the nonunion site. Supplementary fixation of the graft with a micro suture anchor into the scaphoid was used in 66 patients. At follow-up each patient was evaluated with clinical and radiographic examination.
Results and Conclusions: At a mean time of 12.3 weeks (range, 6-24) after surgery, solid union was achieved in 76 of 89 patients (49 of 58 with avascular necrosis). Eleven patients had persistent non-union and two fibrous union as determined by CT scan. Sixty-six of the patients with solid bone union were completely pain free and ten complained of slight pain with strenuous activities. Wrist flexion and extension were improved postoperatively. The average grip strength at the final follow-up was 84% of the contralateral arm, compared with 67% before surgery. The mean modified Mayo wrist score significantly improved from 42 to 87. No arthritic changes were noted at the dorsal ridge of the radius. No donor site morbidity was observed.
Results of the use of a capsular-based vascularized bone graft from the distal radius for scaphoid nonunions compare favorably with the results of pedicled or free vascularized grafts. The capsular-based vascularized bone graft from the distal radius is a reliable alternative technique for scaphoid nonunions. It is a simple technique that eliminates the need for dissection of small-caliber pedicle or microsurgical anastomoses. The supplemental fixation with a micro suture anchors eliminates the risk of graft displacement.
