Using a vascularized bone graft from the distal metaphysis of radius in treating scaphoid nonunion: first report from a developing country.

Abstract

Scaphoid fractures are common and prone to nonunion if left untreated. In this study, the outcome of using a vascularized bone graft was investigated in scaphoid nonunion. Twenty patients with scaphoid nonunion were recruited from Shohada Hospital. A reverse-flow vascularized bone graft was obtained from the distal metaphysis of radius and inserted into the gap of scaphoid fracture. Long and short thumb spica casts were used for 1.5 and 2 months thereafter, respectively. Union, motion, pain and the patients' satisfaction rate were documented. Twenty patients, 19 males and 1 female, with a mean age of 25.15 +/- 6.62 (range: 17-40) years were studied. The fractured were in the waist of the bone in 17 cases and in the proximal pole in 3 cases. Preoperative pain and pain plus compromised grip strength were reported in 11 and 9 patients, respectively. The rate of patients with pain decreased significantly after operation (100 to 25%; p < 0.001). Complications happened in 7 patients (35%) after operation including pin fracture (n = 2), change of occupation (n = 2), nonunion (n = 1), delayed union (n = 1) and irritation (n = 1). Union achieved after 10.71 +/- 1.62 (range: 8-14) weeks in average, post-operation. Mayo wrist score improved significantly at the endpoint. The range of motion of the wrist did not change significantly after operation. Eighty percent of the patients rated the satisfaction rate as good to excellent. This study is the first one from a developing country indicating that the technique of using a reverse-flow vascularized bone graft in treating scaphoid nonunion is considerably successful and safe.