Background:Many studies have demonstrated superiority of
vascularized graft over non-vascularized in management of scaphoid
nonunion, especially with sclerotic fracture edges with poor
vascularity, and in proximal pole fractures or in presence of avascular
necrosis. The aim of the current study was to assess the outcome of
vascularized pedicled 1,2- ICSRA graft in management of scaphoid
nonunion.
Patients and Methods: Between May 2011 and May 2014, 20
patients with scaphoid nonunion were prospectively enrolled in the
current study. Exclusion criteria included radioscaphoid arthritis. All
patients were males with the non-dominant hand affected in 15 and
the dominant in 5 patients. The average age was 32.5 (range, 21 to
40). Eight patients were manual workers, 5 were students, and 7 had
an office based work. The mechanism of injury was fall on
outstretched hand in 13 patients, and sport related injuries in the other
7. There were 15 waist fractures and 5 proximal pole fractures. All
patients treated by vascularized pedicled 1,2- ICSRA graft fixed by
Herbert screw.
Results: The average follow-up period was 18 months (range, 12 to
30). Union was obtained in all cases in an average of 11.3 weeks
(range, 5-30). The mean time to union in proximal pole fractures was
12.3 weeks (rang, 6-30). While that of waist fractures was 10.4 weeks
(range, 5-20). At the final follow up, the average pain VAS improved
from 4.3 (range 2 to 6) preoperatively to 0.45 (range, 0 to 3)
postoperatively. This improvement was statistically significant
(p,0.0001). Seventeen of our patients (85%) became totally pain free
while the remaining 3 patients had mild pain on strenuous activities.
The average flexion and extension range improved from 65% and
61% to 74% and 75% respectively (p |
