Purpose
Vascularized bone grafting has been proposed as a treatment for scaphoid nonunions
with avascular necrosis of the proximal pole. The purpose of this investigation is
to report the results of vascularized bone graft and internal fixation for established
scaphoid nonunions with proximal pole avascular necrosis as measured by validated
outcome instruments.
Methods
From 1996 to 2004, 30 consecutive patients with established scaphoid nonunion, proximal
pole avascular necrosis, and no prior surgery were treated with open reduction and
internal fixation in addition to a vascularized bone graft based on 1,2 intercompartmental
supraretinacular artery. A total of 19 patients had nonunions of the scaphoid waist
and 11 had nonunions of the proximal pole of the scaphoid. Preoperative and postoperative
evaluation included measurement of clinical (grip strength and range of motion), radiographic
(scapholunate angle, scaphoid height-to-length ratio, and radioscaphoid arthritis),
function (Disabilities of the Arm, Shoulder, and Hand questionnaire) and satisfaction
parameters. We recorded union and return to activity and analyzed data both in the
aggregate and stratified by nonunion location.
Results
Union rate was 28 of 30 (93%) and time to union was 5.1 months (±2.4). Significant
improvements were found for grip strength, Disabilities of the Arm, Shoulder, and
Hand score, satisfaction score, and scaphoid height-to-length ratio (p < .01). No
significant difference was found for composite wrist range of motion. Two patients
experienced complications and required a second procedure to achieve union. A total
of 28 of 30 (93%) of patients returned to work or sports activity at their preinjury
level.
Conclusions
The results of this investigation support the use of a vascularized bone graft for
the treatment of scaphoid nonunions with avascular necrosis of the proximal pole.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
November 20,
2008
Received:
December 20,
2007
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 Published by Elsevier Inc.
