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Treatment for proximal pole scaphoid nonunion with capsular-based vascularized distal radius graft

  • Loukia K. Papatheodorou
  • Dean G. SotereanosEmail author
Original Article • WRIST - MICROSURGERY
  • 60 Downloads

Abstract

Purpose

We retrospectively reviewed the results of 89 patients with proximal pole scaphoid nonunion, 58 with avascular necrosis, treated with a capsular-based vascularized distal radius graft.

Methods

Seventy-one male and eighteen female patients with symptomatic nonunion at the proximal pole of the scaphoid were included in this study. No patient had a humpback deformity. In all patients, the vascularized bone graft was harvested from the dorsum of the distal radius and was attached to a capsular flap of the dorsal wrist capsule. After fixation of the scaphoid with a small cannulated screw, the graft was inserted press-fit into the scaphoid trough in the nonunion site. Supplementary fixation of the graft with a microsuture anchor into the scaphoid was used in 66 patients.

Results

At a mean time of 12.3 weeks (range 6–24) after surgery, solid union was achieved in 76 of 89 patients (49 of 58 with avascular necrosis). Eleven patients had persistent nonunion and two fibrous union as determined by CT scan. Sixty-six of the patients with solid bone union were completely pain free, and ten complained of slight pain with strenuous activities. No donor site morbidity was observed.

Conclusions

The capsular-based vascularized bone graft from the distal radius is a reliable alternative technique for scaphoid nonunions. It is a simple and expedient harvesting technique without the need for a microsurgical anastomoses. The supplemental fixation with a microsuture anchor eliminates the risk of graft displacement.

Keywords

Scaphoid avascular necrosis Scaphoid nonunion Scaphoid proximal pole Vascularized bone graft 

Notes

Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, University of Pittsburgh School of MedicineOrthopaedic Specialists - UPMCPittsburghUSA

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