Nonunion of the scaphoid treated by anterior vascular- ized bone graft: a review of 26 cases

Abstract

【Abstract】Objective: To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid. Methods: This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot’s classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobi- lization period was 9 weeks. Results: At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18°. Nineteen patients (73%) were free of pain, and the others had occasional pain Conclusions: It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion. Key words: Scaphoid bone; Pseudarthrosis; Bone transplantation; Radius