Treatment of Scaphoid Nonunions Using a Pronator Quadratus Pedicled Bone Graft

Mun Suk Jang; Yu Seok Seo

doi:10.0000/jkssh.2012.17.4.159

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Jang and Seo: Treatment of Scaphoid Nonunions Using a Pronator Quadratus Pedicled Bone Graft

Original Article

Journal of the Korean Society for Surgery of the Hand

Journal of the Korean Society for Surgery of the Hand 2012; 17(4): 159-165.

Published online: 31 December 2012

DOI: https://doi.org/10.0000/jkssh.2012.17.4.159

Treatment of Scaphoid Nonunions Using a Pronator Quadratus Pedicled Bone Graft

Mun Suk Jang¹, Yu Seok Seo²

¹Republic of Korea Air Force l8st Fighter Wing Medical Center, Gangneung, Korea.

²Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Correspondence to: Mun Suk Jang. Republic of Korea Air Force l8st Fighter Wing Medical Center, 117 Wall Ho Pyong street, Hak dong, Gangneung 210-060, Korea. TEL: +82-33-649-3602, FAX: +82-33-645-8026, jjangdol13@hanmail.net

Received 25 August 2012 Revised 4 November 2012 Accepted 19 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to evaluate the clinical results of the treatment of scaphoid nonunions using a pronator quadratus pedicled bone graft.

Methods

Thirteen patients with a scaphoid nonunion were treated with pronator quadratus pedicled bone graft. The average age of the patients was 20.23 years (range: 19-22 years) and the minimum follow-up period was one year. In all patients, bone grafting was performed and screw was fixed by using a volar aspect of distal radius bone graft with pronator quadratus muscle.

Results

All 13 patients showed radiographic union with the average union time of 10.8 weeks (range: 9-13 weeks). Flexion, extension, radial deviation and ulnar deviation of wrist joint improved compared to the preoperative condition (p<0.05). Postoperative scapholunate and radiolunate angle improved compared to the preoperative condition (p<0.05). Eleven patients (84.5%) showed excellent or good results according to Herbert and Fisher's score criteria of functional, subjective satisfaction and radiographic result.

Conclusion

Pronator quadratus pedicled bone grafting can be considered to be easily accessible technique on vascularized bone graft for osteosynthesis of scaphoid nonunions. It is proved to be effective for bone union, increased wrist joint motion.

Keywords: Scaphoid, Nonunion, Pronator quadrates pedicle bone graft

Figures and Tables

Fig. 1

(A) The pronator quadratus pedicled bone graft is obtained from styloid process of distal radius. Bone graft was inserted into the non-union site and fixed using Acutrack compression crew. (B, C, D) Intraoperative photographs show the surgical approach between the flexor carpi radialis and radial vessels, the graft after its detachment from the styloid process of the raidus and its insertion into the non-union site.

Fig. 2

A 21-year-old man underwent the osteosynthesis using pronator quadratus pedicled bone grafting. (A) Preoperative plain radiograph shows scaphoid waist non-union. (B) Preoperative computed tomography image shows sclerotic change of proximal fragment and osteophytes. (C) Postoperative X-ray. (D) At 9 weeks after operation, healing was achieved and clinical result was excellent.

Table 1

Demographic data

AVN: avascular necrosis.

Table 2

Herbert and Fisher's score

Table 3

Comparison of postoperative and preoperative values

Table 4

The Overall results of pronator quadrates pedicle bone graft of non-uinon scaphoid fracture (Herbert and Fisher's score)

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