Journal List > J Korean Soc Surg Hand > v.19(4) > 1106467

J Korean Soc Surg Hand. 2014 Dec;19(4):173-179. Korean.
Published online December 31, 2014.  https://doi.org/10.12790/jkssh.2014.19.4.173
Copyright © 2014. The Korean Society for Surgery of the Hand
Scaphoid Nonunions Treated with 1, 2-Intercompartment Supraretinacular Artery Pedicled Vascularized Bone Graft and Headless Compression Screw Fixation
Dong-Hyun Kim, Yang-Guk Chung, Seung-Han Shin, Ho-Jin Gil, Jin-Woo Kang and Han-Seok Cho
Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Yang-Guk Chung. Department of Orthopedic Surgery, Seoul St. Mary' Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. TEL: +82-2-2258-2837, FAX: +82-2-535-9834, Email: ygchung@catholic.ac.kr
Received November 19, 2014; Revised December 08, 2014; Accepted December 09, 2014.

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

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.

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

Figures


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.
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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.
Click for larger image


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.
Click for larger image

Tables


Table 1
Summary of cases (ROM, grip power, NYOH score, Green-O'Brien score and radiologic results)
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Notes

*This paper was introduced at 2013 Annual Meeting of the Korean Orthopaedic Association.

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