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Comparative Study
. 2025 Oct;50(10):1279.e1-1279.e9.
doi: 10.1016/j.jhsa.2024.11.022. Epub 2025 Jan 24.

Comparing the Palmar Radiocarpal Artery Vascularized Bone Graft with Alternatives for Unstable Scaphoid Nonunions: A Retrospective Analysis

Louis-Philippe Baisi  1 , Marc-Antoine Ricard  1 , Melanie Dodd-Moher  2 , Taryn Hodgdon  3 , Manisha Mistry  1 , Braden Gammon  4
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Free article
Comparative Study

Comparing the Palmar Radiocarpal Artery Vascularized Bone Graft with Alternatives for Unstable Scaphoid Nonunions: A Retrospective Analysis

Louis-Philippe Baisi et al. J Hand Surg Am. 2025 Oct.
Free article

Abstract

Purpose: We compared the radiographic union and magnitude of humpback deformity correction when using different vascularized bone grafts (VBGs) and nonvascularized bone grafts (NVBGs) in the treatment of unstable scaphoid nonunions (USNUs).

Methods: This was a retrospective radiographic review of 93 patients with an USNU treated between 2013 and 2022 at a single center by a single surgeon. Inclusion criteria included skeletally mature patients with radiographic evidence of an USNU resulting from failure of either nonsurgical or operative treatment. There were three treatment groups. Two groups were treated with either a palmar radiocarpal artery (PRCA) VBG or a 1,2 intercompartmental supraretinacular (1,2 IC-SRA) VBG. The third group comprised patients who were treated with a heterogeneous mix of NVBGs. Patients were followed radiographically at regular intervals until they were deemed healed or underwent a salvage procedure because of treatment failure. Measurements of carpal and scaphoid alignment were then repeated on the final imaging series and compared to preoperative measurements.

Results: Ninety patients were included in the final analysis. PRCA VBG had the highest radiographic union rate, followed by 1,2 IC-SRA VBG and finally NVBGs. PRCA VBG had a significantly higher rate of union than NVBGs. Scapholunate angle change and scaphoid length change were greatest with PRCA VBG. These differences were statistically significant for the former when compared with 1,2 IC-SRA VBG and NVBGs and for the latter when compared with the 1,2 IC-SRA VBG in both univariate and multivariable analyses.

Conclusions: PRCA VBG had the highest radiographic union rate compared with alternative grafts as well as providing the greatest degree of humpback deformity correction in the treatment of USNUs.

Type of study/level of evidence: Therapeutic IV.

Keywords: Deformity correction; dorsal intercalated segment instability; nonvascularized bone graft; scaphoid nonunion; vascularized bone graft.

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Conflict of interest statement

Conflicts of Interest This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All authors declare that they have no conflicts of interest to disclose.

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