Background
Zaidemberg and Colleagues (1991) were the first to describe the dorsal distal radius as a source ofa vascularized graft for long standing scaphoid nonunion. At the present time, the 1& 2 intercompartmental supraretinacular artery, remains the workhorse for vascularized scaphoid grafts.
Patients and Methods
Over a period of 2 years, 20 male patients with established scaphoid nonunion of more than 6 months duration were operated upon using a vascularized dorsal radius graft based on 1& 2 intercompartmental supraretinacular artery. Supplemental internal fixation by Herbert screw was done for the scaphoid nonunion. The average age of the patients was 26.7 years (range 19-38). Pre-operative clinical evaluation was done for all patients using the modified Mayo wrist score. Radiological evaluation using different x-ray views for all patients, C. T and M.
R.Ifor selected patients. The average follow-up period ofthe patients was 5.65 months (range 4 -12 months).
Results
Union was obtained in all cases as proved by clinical examination and radiographic evaluation. The mean time to union was 11.35 weeks (range 6-22 weeks). The overall functional outcome of the patients improved after surgery as noticed by the post-operative increase of modified Mayo wrist score by a mean of 19 points. At the final follow-up, 17 patients were rated good (85%) and 3 patients were rated fair (15%)Scapholunate angle improved significantly by a mean of 160 following the surgery and carpal height ratio increased significantly to
0.52 post-operatively. No major complications were reported in this series.
Conclusion
Operative treatment ofscaphoid nonunion by pedicled vascularized bone graft technique gives good results in most cases and provides the opportunity for improving normal scaphoid alignment and permanent improvement in carpal instability. |
