Objective: The scaphoid bone is the most injured carpal bone and is the cause of severe wrist dysfunction seen in nonunion cases. The probability of avascular necrosis is very high especially in fractures of the proximal pole, due to the retrograde blood flow in the region. In these cases, vascularized pedicle bone grafts, with high rates of union, is a good alternative to the conventional techniques. In this study, we present the results of vascularized bone grafting with grafts harvested from the 4-5 extensor compartment artery (ECA) and fixation with the Herbert screw in patients with avascular pseudoarthroses of the scaphoid proximal pole.
Methods: Fifteen patients who presented to our clinic due to nonunion of the scaphoid and who were applied vascularized pedicle bone grafts harvested from the ECA between 2006 and 2015 were included in the study. The mean age of the patients was 30.1 (19-42) and all patients were male. Patients were followed up for an average period of 22.7 (18-56) months. Union in the patients were evaluated with the preoperative and postoperative wrist ranges of motion. VAS (visual analog scale) and, for functional evaluation, the Turkish version of the Quick-DASH scale were used.
Results: Union was achieved in all patients after a mean period of 8.2 (6-10) weeks. The most significant improvements after surgery were detected in the VAS and functional Quick-DASH scores. No significant improvement was observed in wrist contractures. Other than the hematoma in one patient, no complication was observed.
Conclusion: In cases of nonunion of the scaphoid proximal pole fractures accompanied by avascular necrosis, pedicle grafts from the 4-5 ECA offer high rates of union and improvement in the pain and functional scores of the patients. Level of evidence Level IV, therapeutic study.