Vascularized Bone Graft Based on First and Second Inter-Compartmental Supraretinacular Artery in the Treatment of Scaphoid Nonunion: Our Experience

Abstract

Objective: We aimed to evaluate the results of using a First and Second Inter-Compartmental Supraretinacular Artery (1,2-ICSRA) based vascularized bone graft (VBG) when performing Herbert screw fixation in scaphoid nonunion. Methodology: This is a retrospective study from January 2017 to August 2020 with a total of 16 patients. All those aged<50 years, fracture <2 yrs old, no previous surgical intervention on the fracture, and stage 1 or 2 degenerative changes at the fracture site were included. Patients with avascular necrosis of the scaphoid were excluded. All patients were radiologically examined. Herbert screw fixation was done under general anesthesia and a wedge-shaped VBG from the radius was placed at the nonunion site. Results: There were 12 males and 4 females with a mean age of 30.25±8.88 years. Chronic wrist pain at rest was completely relieved in all patients while the pain with motion was markedly diminished in 10 and eliminated in two. The average range of motion, pinch, and grip strength of the wrist improved after surgery. Power assessment showed that the mean power before surgery was significantly raised from 67.50±5.83 to 95.06±4.45 Kgs (p=0.001). The mean intensity of pain before surgery i.e. 5.54±1.36 reduced to 2.25±0.78 (p<0.001). Conclusion: We found excellent results when used Herbert screws along with a 1,2-ICSRA based VBG in patients with scaphoid nonunion, where the union was achieved in all and significant improvement was seen when power and pain were assessed.