Clinico-radiological assessment of vascularized muscle pedicle bone graft in scaphoid non-union
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243904Keywords:
Scaphoid non-union, Avascular proximal pole, Muscle pedicle bone graftAbstract
Background: The aim of this study was to assess the clinico-radiological outcome of vascularised muscle pedicle bone graft in scaphoid non-union.
Methods: 16 men and 8 women with non-union of the scaphoid involving the proximal pole (n=6), waist (n=14), and distal pole (n=4) were randomly assigned to receive a vascularized muscle pedicle bone transplant with Herbert screw fixation. Their ages ranged from 18 to 45 (mean 32). Eight months was the average non-union period (range: 4–12 months).
Results: The mean follow-up duration was 18 months. 20 out of 24 were united. In 16 out of 24 cases, the scapholunate and radiolunate angles were corrected. 4 of 24 did not achieve union, and 3 of those were associated with proximal pole absorption. During pedicle dissection, there was no iatrogenic fracture or hardware malfunction.
Conclusions: Scaphoid non-union has been successfully treated with vascularized bone grafts, particularly in cases where the non-union has an avascular proximal pole or has not healed following prior surgery.
Metrics
References
Rajagopalan BM, Squire DS, Samuels LO. Results of Herbert-screw fixation with bone-grafting for the treatment of nonunion of the scaphoid. J Bone Joint Surg Am. 1999;81:48-52.
Lindstrom G, Nystrom A. Natural history of scaphoid non-union, with special reference to “asymptomatic” cases. J Hand Surg Br. 1992;17:697-700.
Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br. 1989;71:307-10.
Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br. 1996;78:519-29.
Robbins RR, Ridge O, Carter PR. Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles. J Hand Surg Am. 1995;20:818-31.
Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am. 1991;16:474-8.
Sunagawa T, Bishop AT, Muramatsu K. Role of conventional and vascularized bone grafts in scaphoid nonunion with avascular necrosis: a canine experimental study. J Hand Surg Am. 2000;25:849-59.
Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am. 1985;10:597-605.
Braun RM. Pronator pedicle bone grafting in the forearm and proximal carpal row. Orthop Trans. 1983;7:35.
Chacha PB. Vascularised pedicular bone grafts. Int Orthop. 1984;8:117-38.
Kawai H, Yamamoto K. Pronator quadratus pedicled bone graft for old scaphoid fractures. J Bone Joint Surg Br. 1988;70:829-31.
Herbert TJ. The fractured scaphoid. St Louis: Quality Medical Publishing. 1990;31-3.
Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66:114-23.
Daly K, Gill P, Magnussen PA, Simonis RB. Established nonunion of the scaphoid treated by volar wedge grafting and Herbert screw fixation. J Bone Joint Surg Br. 1996;78:530-4.
Bunker TD, McNamee PB, Scott TD. The Herbert screw for scaphoid fractures. A multicentre study. J Bone Joint Surg Br. 1987;69:631-4.
Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42:759-68.
Jiranek WA, Ruby LK, Millender LB, Bankoff MS, Newberg AH. Long-term results after Russe bone- grafting: the effect of malunion of the scaphoid. J Bone Joint Surg Am. 1992;74:1217-28.
Stark HH, Rickard TA, Zemel NP, Ashworth CR. Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation. J Bone Joint Surg Am. 1988;70:982-91.
Cooney WP 3rd, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg Am. 1980;5:343-54.