J Korean Soc Surg Hand.  2014 Dec;19(4):173-179. 10.12790/jkssh.2014.19.4.173.

Scaphoid Nonunions Treated with 1, 2-Intercompartment Supraretinacular Artery Pedicled Vascularized Bone Graft and Headless Compression Screw Fixation

• Kim DH
• Chung YG
• Shin SH
• Gil HJ
• Kang JW
• Cho HS

• KMID: 1896906
• DOI: http://doi.org/10.12790/jkssh.2014.19.4.173

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical results of scaphoid nonunions treated with 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone grafting (VBG) and headless compression screw fixation.
METHODS
Since August 1, 2005, 11 scaphoid nonunions with avascular necrosis or bone marrow edema of proximal fragments were managed with 1, 2-ICSRA pedicled VBG combined with headless compression screw fixation. The mean age was 37.1 years (range, 21-66 years). 8 patients had avascular necrosis (AVN) of proximal fragments and 3 patients had bone marrow edema in proximal fragments. Serial radiographic evaluations were performed in every 4-8 weeks for bone union and follow up computed tomography scanning were checked in 8 patients.
RESULTS
Bone unions were obtained in all 11 patients at 4.9 months (range, 3-9 months) after operation. At last follow up, the average range of motion was 82.5% and the grip power was 84.1% compared to the contralateral side. The mean New York Orthopaedic Hospital wrist score at last follow up was 83.2 (range, 58.1-93.3).
CONCLUSION
Combined 1, 2-ICSRA pedicled VBG and headless compression screw fixation were reliable methods for managements of scaphoid nonunions even with AVN at proximal fragments.

Keyword

Scaphoid nonunion; Avascular necrosis; 1, 2-Intercompartment supraretinacular artery pedicled vascularized bone graft; Headless compression screw fixation

MeSH Terms

Arteries*
Bone Marrow
Bone Transplantation
Edema
Follow-Up Studies
Hand Strength
Humans
Necrosis
Range of Motion, Articular
Transplants*
Wrist

Figure

• 

  Fig. 1. Technique of 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone graft using a dorsal approach for scaphoid nonunions. (A) The 1, 2-ICSRA pedicled vascularized bone graft was elevated from the dorsal surface of distal radius. The perfusion status of elevated bone graft was confirmed after tourniquet release. (B) After headless compression screw fixation, a slot for pedicled vascularized bone graft was prepared at dorsal surface of scaphoid with osteotome and curet.

• 

  Fig. 2. The patient with a complaining of right wrist pain for 1 year. (A) The radiograph showed nonunion & sclerotic change of scaphoid proximal pole. (B) Magnetic resonance imaging showed avascular necrosis of proximal pole of scaphoid. (C) Headless compression screw fixation and 1, 2-intercompartment supraretinacular artery pedicled vascularized bone graft were performed. (D) At postoperative 3 months, complete bone union has progressed.

• 

  Fig. 3. The patient has been complaining with a right wrist pain for 1 year. (A) The radiograph showed scaphoid nonunion and sclerotic change. (B) Magnetic resonance imaging showed bone marrow edema of whole proximal fragment and large portion of distal fragment of scaphoid, which suggested precarious perfusion status. (C) 1, 2-intercompartment supraretinacular artery pedicled vascularized bone graft and headless compression screw fixation were performed. (D) At postoperative 12 months, computed tomography scan revealed progression of bone union and no more scaphoid collapse.

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