Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius

• DOI: 10.1007/s00264-009-0862-6
• Publication Date: 2009-09-02T18:09:05Z
• Authors: Samuel Ribak; Carlos Eduardo Go...; Rames Mattar; Heitor Jose Rizza...; Marcelo Rosa de R...; Mauricio Etchebehere
• Keywords: Fracture Healing; Scaphoid Bone; Bone Transplantation; Hand Strength; Prostheses and Implants; Recovery of Function; Wrist Injuries; Radius; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Patient Satisfaction; Fractures, Ununited; Activities of Daily Living; Humans; Range of Motion, Articular

We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p=0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.