Vascularized bone graft pedicled on the volar carpal artery from the volar distal radius as primary procedure for scaphoid non-union - 24/11/11

Doi : 10.1016/j.otsr.2011.08.008

M. Gras ^a,^⁎ , C. Mathoulin ^b
^a Nollet Locomotor System Institut, 23, rue Brochant, 75017 Paris, France
^b Hand Institute, Jouvenet Clinic, 75016 Paris, France

Corresponding author.

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Summary

Introduction

The treatment of scaphoid non-union with non-vascularized bone graft leads to non-union in 10 to 20% of cases and up to 50% in case of proximal pole necrosis. Vascularized bone graft improves consolidation rates, but is generally restricted to secondary scaphoid non-union.

Hypothesis

This study assessed the value of a primary vascularized bone graft pedicled on the transverse volar carpal artery from the volar aspect of the distal radius as donor site.

Patients and methods

This retrospective study included 111 cases of vascularized bone graft for scaphoid non-union as primary procedure in 73 cases and secondarily in 38. The procedures were performed through a single incision.

Results

Mean delay before surgery was 25.5 and 33months respectively, with union rates of 96% and 89.5%. Results showed improvement in both groups, but were better in primary surgery in terms of range of motion, strength, pain, function, satisfaction and return to work. There were more complications with secondary surgery.

Discussion

All reports agree that union is better with vascularized bone graft. This technique performed as a day of admission surgery through a single incision under locoregional anesthesia seems feasible as a primary intervention.