Vascularized Pedicled Distal Radius Bone Graft for Scaphoid Nonunion in Wrist

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Journal of the Korean Society for Surgery of the Hand 2005;10(4):199-207.
Published online December 1, 2005.

Seok-Whan Song, M.D., Seung-Koo Rhee, Ki-Won Kim, M.D., Hwa-Sung Lee, Hyo-Jin Lee

혈행성 혈관경 원위요골을 이용한 수근관절 주상골 불유합의 치료

송석환, 이승구, 김기원, 이화성, 이효진

Abstract

Nonunion and avascular necrosis of proximal pole after scaphoid fracture in wrist are still challenging for hand surgeons. Many authors have been reported various types of vascularized bone graft to achieve higher union rate and revascularization of proximal pole of scaphoid. We performed the vascularized pedicled distal radius bone graft (VDRBG), and evaluated the efficacy of the procedure for the treatment of scaphoid nonunion. Fourteen patients of scaphoid nonunions were operated using the VDRBG. VDRBG was pedicled mainly with 1,2-intercompartmental supraretinacular artery (ICSRA) and 2,3-ICSRA in only two cases. The fracture site was fixed with K-wires in most cases, and an AcutrakⓇ screw in three cases. Usually cancellous bone graft was added from the anterior iliac crest or Lister’s tubercle. There were evidences of callus as early as 3 weeks after the operation and the average period of visible callus was 5.7 weeks after the operation. All scaphoid nonunions were successfully healed without any further operations (mean union time: 8.9 weeks), and there was no collapse during the average follow up period of 1 year and 7 months. From the above results, we concluded the ICSRA VDRBG as the one of definite solutions for the problematic scaphoid nonunion of wrist.

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