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. 2023 Oct 22;15(10):e47489.
doi: 10.7759/cureus.47489. eCollection 2023 Oct.

The Outcome of Scaphoid Fracture Nonunion Managed by 1,2 Intercompartmental Supraretinacular Artery (1,2 ICSRA) Vascularized Bone Graft

Md Mohiuddin  1 , Bipul K Das  2 , Raquib M Manzur  2 , Jahangir Alam  2 , Syed E Shaude  3
Affiliations

The Outcome of Scaphoid Fracture Nonunion Managed by 1,2 Intercompartmental Supraretinacular Artery (1,2 ICSRA) Vascularized Bone Graft

Md Mohiuddin et al. Cureus. .

Abstract

Background: Scaphoid fracture is most often missed and mismanaged leading to scaphoid nonunion with or without avascular necrosis. When avascular necrosis of the proximal pole is confirmed with intraoperative evaluation, conventional bone graft is not enough. The treatment modalities are evolving day by day. The current trend is vascular bone grafting, which has shown good outcomes in terms of union and wrist function.

Methods: Fifty patients with nonunion fracture of the scaphoid were treated with vascularized pedicle bone graft from the dorsum of the distal radius using the 1st and 2nd intercompartmental supraretinacular artery, from 2014 to 2022. Preoperative and postoperative clinical evaluation included pain, range of motion, grip strength, and satisfaction. The average follow-up period was 12 months.

Results: Among 18 patients, 14 were clinically improved after a mean follow-up period of eight weeks. Thirteen patients reported the absence of any discomfort, three patients reported slight discomfort after hard work, and two patients reported pain with light work. The wrist range of motion improved significantly, and the hand grip strength also improved. According to the modified Mayo wrist scoring chart, clinical results were rated as excellent in 24 cases, good in 19 cases, and poor in four cases.

Conclusion: 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) is superficial to the extensor retinaculum and is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.

Keywords: avascular necrosis; avn; outcome; scaphoid non-union; treatment; vascularized bone graft.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. (a) Preparation of fracture site. (b & c) Harvesting of vascularized graft. (d) Inset of the graft to the fracture site. (e) Insertion of guidewire.
Figure 2
Figure 2. (a) Preoperative image showing fracture at the waist of scaphoid. (b) Follow-up image three months following surgery. (c) Image taken six months after surgery. (d) Measuring grip strength at final follow-up. (e) Range of movement of the wrist six months after surgery.
Figure 3
Figure 3. Distribution of results according to the modified Mayo wrist score.
See this image and copyright information in PMC

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