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.
Similar content being viewed by others
References
Gelberman RH, Menon J (1980) The vascularity of the scaphoid bone. J Hand Surg Am 5(5):508–513
Simonian PT, Trumble TE (1994) Scaphoid nonunion. J Am Acad Orthop Surg 2(4):185–191
Pinder RM, Brkljac M, Rix L, Muir L, Brewster M (2015) Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am 40(9):1797–1805. https://doi.org/10.1016/j.jhsa.2015.05.003
Merrell GA, Wolfe SW, Slade JF 3rd (2002) Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am 27(4):685–691
Munk B, Larsen CF (2004) Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5246 cases of scaphoid nonunion. Acta Orthop Scand 75(5):618–629
Zaidemberg C, Siebert JW, Angrigiani C (1991) A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am 16(3):474–478
Mathoulin C, Haerle M (1998) Vascularized bone graft from the palmar carpal artery for treatment of scaphoid nonunion. J Hand Surg Br 23(3):318–323
Guimberteau JC, Panconi B (1990) Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery. J Bone Joint Surg Am 72(1):88–97
Fernandez DL, Eggli S (1995) Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting. J Bone Joint Surg Am 77(6):883–893
Gabl M, Reinhart C, Lutz M, Bodner G, Rudisch A, Hussl H, Pechlaner S (1999) Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment. J Bone Joint Surg Am 81(10):1414–1428
Meisel E, Seal A, Yao CA, Ghiassi A, Stevanovic M (2017) Management of scaphoid nonunion with iliac crest bone graft and K-wire fixation. Eur J Orthop Surg Traumatol 27(1):23–31. https://doi.org/10.1007/s00590-016-1876-6
Higgins JP, Bürger HK (2018) The use of osteochondral flaps in the treatment of carpal disorders. J Hand Surg Eur 43(1):48–56. https://doi.org/10.1177/1753193417739545
Sotereanos DG, Darlis NA, Dailiana ZH, Sarris IK, Malizos KN (2006) A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis. J Hand Surg Am 31(4):580–587
Venouziou AI, Sotereanos DG (2012) Supplemental graft fixation for distal radius vascularized bone graft. J Hand Surg Am 37(7):1475–1479. https://doi.org/10.1016/j.jhsa.2012.04.024
Dailiana ZH, Malizos KN, Urbaniak JR (2005) Vascularized periosteal flaps of distal forearm and hand. J Trauma 58(1):76–82
Bumbaširević M (2017) Scaphoid nonunion: special edition. Eur J Orthop Surg Traumatol 27(1):1–2. https://doi.org/10.1007/s00590-016-1872-x
Boyer MI, von Schroeder HP, Axelrod TS (1998) Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg Br 23(5):686–690
Chang MA, Bishop AT, Moran SL, Shin AY (2006) The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am 31(3):387–396
Malizos KN, Zachos V, Dailiana ZH, Zalavras C, Varitimidis S, Hantes M, Karantanas A (2007) Scaphoid nonunions: management with vascularized bone grafts from the distal radius: a clinical and functional outcome study. Plast Reconstr Surg 119(5):1513–1525
Waitayawinyu T, McCallister WV, Katolik LI, Schlenker JD, Trumble TE (2009) Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg Am 34(3):387–394. https://doi.org/10.1016/j.jhsa.2008.11.023
Malizos KN, Dailiana Z, Varitimidis S, Koutalos A (2017) Management of scaphoid nonunions with vascularized bone grafts from the distal radius: mid- to long-term follow-up. Eur J Orthop Surg Traumatol 27(1):33–39. https://doi.org/10.1007/s00590-016-1867-7
Harpf C, Gabl M, Reinhart C, Schoeller T, Bodner G, Pechlaner S, Piza-Katzer H, Hussl H (2001) Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases. Plast Reconstr Surg 108(3):664–674
Straw RG, Davis TRC, Dias JJ (2002) Scaphoid nonunion: treat- ment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery. J Hand Surg Br 27(5):413–416
Doi K, Oda T, Soo-Heong T, Nanda V (2000) Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am. 25(3):507–519
Fernandez DL (1984) A technique for anterior wedge-shaped grafts for scaphoid nonunions with carpal instability. J Hand Surg Am 9(5):733–737
Fernandez DL (1990) Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions. J Hand Surg Am 15(1):140–147
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors have no conflict of interest.
Rights and permissions
About this article
Cite this article
Papatheodorou, L.K., Sotereanos, D.G. Treatment for proximal pole scaphoid nonunion with capsular-based vascularized distal radius graft. Eur J Orthop Surg Traumatol 29, 337–342 (2019). https://doi.org/10.1007/s00590-018-2329-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-018-2329-1