1,2 Intercompartmental Supraretinacular Artery-Based Vascularized Graft for Scaphoid Nonunion With Avascular Necrosis

Abstract

Background The treatment for scaphoid nonunion with avascular necrosis is vascularized and non-vascularized bone grafts. A vascularized bone graft promotes biological healing and revascularizes ischemic bone. The purpose of this retrospective study is to analyze the outcome of 1,2 intercompartmental supraretinacular artery (1,2-ICSRA)-based vascularized graft in scaphoid nonunion with avascular necrosis. Materials and methods We treated 11 patients with scaphoid nonunion with avascular necrosis using a (1,2-ICSRA)-based vascular graft and Herbert screw fixation between 2013 and 2017. Plain radiographs, computed tomography (CT) scan, magnetic resonance imaging (MRI) confirmed the avascular necrosis in all patients. We noted the age, delay in treatment, time for bone union, preoperative range of movements, grip strength, scapholunate, intrascaphoid angle, and radiolunate angles. We confirmed the bone union by CT scan and measured the functional outcome with pain score, modified Mayo wrist score, grip strength, range of movement, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The mean age of the patients was 29 years (range 20-42 years). The mean follow-up was 31 months (range, 26-36 months). All patients achieved good radiological union and revascularization of the proximal pole necrosis at an average of 14 weeks (range, 12-18 weeks). There was a significant postoperative improvement in grip strength, visual analog scale VAS score, intrascaphoid angle, scapholunate angle, and radiolunate angle (p<.05). The mean range of wrist flexion was 88%, extension 70%, radial deviation 80%, and ulnar deviation 85% of the opposite side. Conclusions Scaphoid nonunion with avascular necrosis can be treated with a 1,2-ICSRA-based vascularized bone graft. Vascularized bone grafts promote biological healing and revascularization of the ischemic bone.

Bone grafting for scaphoid nonunion surgery

“…Ten studies reported union rates for patients with proximal pole fractures exclusively with AVN (n = 225). 17,26,39,47,61,62,71,77,83,86 The union rate reported for these cases was 77.6% (95% CI 59.2 to 95.9) and vascularized grafts were used in all cases. One study used a medial femoral condyle graft, and the remaining studies employed grafts from the distal radius.…”

“…There were 13 studies (298 patients) reporting outcomes for patients with AVN, nine of which reported outcomes for AVN only in proximal pole fractures, 17,26,39,47,61,62,71,83,86 while three had a heterogenous range of fracture sites (featuring 36.7% to 73.3% proximal pole fractures), 19,50,82 and one study reported dichotomized outcomes for AVN which involved proximal pole of the scaphoid and those which did not. 77 AVN was variably determined, both by visual appearance at surgery and/or preoperative MRI imaging.…”

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle

“…The proximal scaphoid is at risk of avascular necrosis after fracture, further limiting the potential recovery (Papatheodorou et al, 2021). Several surgical procedures have been developed to try to improve bone union, including various bone grafts (Borges et al, 2020; Jerome et al, 2020; Kim et al, 2018; Pulos et al, 2018). Union rates with traditional bone grafts used for proximal scaphoid nonunion have been reported to be between 64% and 74% (Krimmer, 2002; Morris et al, 2018).…”