Volar vascularized graft from the distal radius in management of ununited scaphoid fractures

ABSTRACT

Scaphoid fracture nonunions often present a therapeutic challenge. This is because the vascular supply of the scaphoid renders the proximal pole in many of these fractures avascular. Recently, vascularized bone grafts for the scaphoid have gained increasing popularity and many methods have been described based on different pedicles aiming to achieve union in these difficult nonunions associated with proximal pole diminished vascularity. In this study, a vascularizsed bone graft from the volar aspect of the distal radius based on the radial portion of the palmar carpal arterial arch was used to treat scaphoid nonunion. Between 1999 and 2004, 31 cases of ununited fractures of the scaphoid were managed by using a vascularized bone graft from the volar aspect of the distal radius and internal fixation using Herbert screws with or without an additional K-wire to hold the graft. There were 29 males and 7 females with a mean age of 31 years [18-46]. Nineteen fractures were associated with DISI. The mean follow up duration was 19 months [11-31]. Bone union was achieved in all patients in an average of 13 weeks [9-20]. There were 13 excellent, 9 good, 8 fair and 1 poor result had it corrected in the postoperative X-ray. Vasculariszed graft from the volar aspect of the distal Radius was found to be a reliable source of bone grafting with the advantage of being simple to harvest with little or no donor site morbidity and associated with a high union rate as well as other advantages as allowing simultaneous correction of humpback deformity and DISI