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. 2014 Jun 27:14:e24.
eCollection 2014.

Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius

Frank Werdin  1 , Patrick Jaminet  1 , Beate Naegele  1 , Matthias Pfau  1 , Hans-Eberhard Schaller  1
Affiliations

Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius

Frank Werdin et al. Eplasty. .

Abstract

Objective: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius.

Methods: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients' data, healing rates, and factors influencing scaphoid healing were analyzed.

Results: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation.

Conclusions: In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole.

Keywords: bone graft; nonunion; reconstruction; scaphoid; vascularized.

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Figures

Figure 1
Figure 1
Intraoperative situs. A 37-year-old male patient suffering from nonunion for 3.5 years. (a) Overview with the scaphoid nonunion right and the green marked vascular pedicle left. (b) Detail out of a; vascular pedicle at the border of the musculus pronator quadratus. (c) Detailed picture after harvesting of the vascular bone graft.
Figure 2
Figure 2
X-rays of a proximal located scaphoid nonunion. A 25-year-old male patient suffering from scaphoid nonunion for 1.5 years. (a) Preoperatively. (b) Preoperative MRI with avascular proximal fragment. (c) Intraoperative aspect with the mini-Herbert screw after dorsal incision, red marked is the harvesting location of the bone graft and its new location in the nonunion site. (d) X-ray investigation after 12 weeks.
Figure 3
Figure 3
X-rays of a proximal located scaphoid nonunion. A 28-year-old male patient suffering from scaphoid nonunion for 2 years. (a) Preoperatively. (b) Intraoperatively with a small k-wire for fixation of the bone graft, palmar approach. (c) 6 weeks postoperatively. (d) 12 weeks postoperatively.
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