Résumé
Objective To evaluate the medium and long term follow-up results of vascularized bone grafts dorsal distal radius in treatment of chronic scaphoid nonunion. Methods A retrospective study was carried out in 13 patients with chronic scaphoid nonunion treated with vascularized bone grafts dorsal distal radius in our hospital from 1995 to 2006. Nine patients were accompanied by avascular necrosis of the proximal pole. The vascular pedicle was 1,2 intercompartmental supraretinacular artery. The nonunion was stabilized by screws or external fixators. Radiographic finding and Mayo scoring system on wrist mobilization were used to evaluate the clinical outcomes. Results The interval between injury and treatment was average 22.2 months. All patients were followed up for average 76.6 months, which showed that 12 patients obtained fracture union, with average union time of 11.2 weeks. Functional evaluation results were defined as excellent in three patients, good in eight and fair in two. The last follow-up revealed significant improvement of the range of motion of the wrist, Mayo scores, grip strength, intrascaphoid angles and scapholunate angles. Conclusions Vascularized bone grafts from dorsal distal radius has relatively surgical procedure and can achieve satisfactory results in management of scaphoid nonunion. The perioperative arthrolysis and early postoperative mobilization of the wrist under exernal fixation play critical role in restoration of wrist function.
Résumé
Objective To evaluate the medium-term follow-up outcomes of treatment of chronic scaphoid nonunion with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery.Methods From February, 1995 to November, 2006, 13 cases of chronic scaphoid nonunion were treated with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery in our hospital. Nine cases were complicated with avascular necrosis of the proximal pole. The interval between injury and treatment averaged 22. 2 months. The nonunions were stabilized by screw or external fixator. Procedures of arthrolysis were applied and early wrist mobilization was initiated under the protection of external fixator. Radiographic finding and Mayo scoring system were used to evaluate the clinical outcomes. Results The mean time of follow-up was 82.9 months. The union time for the 13 cases averaged 11.2 weeks. At the final follow-up,there were 3 excellent, 8 good and 2 fair evaluations;the range of motion of the wrist, Mayo score, grip strength, intrascaphoid angle and scapholunate angle were significantly improved. Conclusions Chronic scaphoid nonunion can be well treated with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery. A simple arthrolysis during the procedure can produce satisfactory results. External fixation plays a critical role in early mobilization and functional restoration of the wrist.