Scaphoid Nonunion Treatment with Reverse Flow Vascularized Bone Graft from Distal Metaphysis of Radius

Abstract

Background: The scaphoid is the most frequently fractured carpal bone. Those fractures are commonly difficult to diagnose and usually go undetected. If the patient does not get medical attention considering that it was a trivial wrist trauma, or if the patient is not appropriately immobilized for enough time, Healing will not occur, partially due to the scaphoid peculiar vascularity. The scaphoid nonunion treatment method is controversial. The aim must be bone healing with scaphoid shape restoration and ligament structure preservation. This study was aimed to evaluate the results of treatment of scaphoid nonunion with reverse flow vascularized bone graft from distal metaphysis of radius. Materials & Methods: In a quasi-experimental setting, 20 patients with scaphoid nonunion in Shohada Trauma Center of Tabriz were evaluated during 13 months. All these were operated and a reverse flow vascularized bone graft from distal metaphysis of radius was employed. Long and short thumb spike casting was applied tow times for 1.5 and 2 months respectively. Radiological union, range of motion, presence of pain and the degree of patients' satisfaction were assessed. Results: Twenty patients, 19 males and 1 female with mean age of 25.15+/- 6.62(17-40) years were recruited. There were 17 waist and 3 proximal pole fractures. Preoperative pain and pain with decreased grip strength was seen in 11 and 9 cases, respectively. Postoperatively, the range of motion did not change significantly. The frequency of patients suffering from pain was significantly decreased at the end of study (100% to 25%; p<0.001). There were 7(35%) complications: pin fracture (2 cases), occupation change (2 cases), nonunion (1 case), delayed union (1 case), and the irritation of pin place (1 case). The man time of union-achievement was 10.71 +/-1.62 (8-14) weeks. Eighty percent of the patients were highly to very highly satisfy with the procedure. Mayo wrist score was significantly increased after operation. Conclusion: This study showed that the treatment of scaphoid nonunion with reverse flow vascularized bone graft from distal metaphysis of radius is safe and effective. The risk of nonunion should be evaluated studies with larger sample sizes. [Jafar Ganjpour sales, Amin Moradi, Jafar Soleimanpour-mokhtarmanand, Yashar Hashemi-aghdam, Behrouz Nazari, Sanaz Rahimi. Scaphoid Nonunion Treatment with Reverse Flow Vascularized Bone Graft from Distal Metaphysis of Radius. Life Sci J 2012; 9(4): 4319-4323]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 646