Resultados del tratamiento de seudoartrosis de escafoides con injerto microvascularizado de arteria 1, 2 intercompartimental suprarretinacular y osteosíntesis / Results of treatment of scaphoid nonunion with microvascularized bone grafts of the 1, 2 intercompartmental supraretinacular artery and osteosynthesis

Objetivo. Estudiar los resultados del tratamiento de la seudoartrosis de escafoides, con dudosa viabilidad del fragmento proximal, pero sin deformidad ni colapso importante del mismo, mediante la utilización de un injerto óseo vascularizado de la arteria suprarretinacular 1,2 intercompartimental (1,2 ICSRA) y osteosíntesis posterior. Material y método. Estudio retrospectivo de 10 pacientes varones con diagnóstico radiográfico de seudoartrosis. Después del tratamiento se evaluó la funcionalidad, el dolor medido por la escala analógica visual (EVA), la fuerza de agarre, la satisfacción del paciente y la reintroducción a la vida laboral, utilizando las escalas de Mayo y QuickDASH específicas de muñeca y comprobándose radiográficamente la integración del injerto. Resultados. El seguimiento medio fue de 31,4 meses; un 90% de las encuestas fueron satisfactorias. La EVA descendió en 4,6 puntos y la ganancia de movilidad flexo-extensora fue de 5°. La tasa de consolidación completa del injerto alcanzó el 40% en 5,5 meses de media. Discusión. Diferentes estudios han demostrado mejores resultados utilizando injerto óseo vascularizado frente al no vascularizado. Desde la descripción por Zaidemberg en 1991, el injerto microvascularizado con arteria 1,2 ICSRA, de radio distal, ha sido el más utilizado para el tratamiento de seudoartrosis del escafoides. Conclusiones. Nuestros resultados, comparables con la bibliografía revisada, utilizando el injerto vascularizado de arteria 1,2 ICSRA y osteosíntesis con tornillo tipo Herbert, pueden ser una alternativa de tratamiento para la seudoartrosis proximal de escafoides, sin colapso ni deformidad importante (AU)

Objective. To analyze the results of treatment of scaphoid nonunion with questionable viability of the proximal fragment, but without significant deformity or collapse, using a vascularized bone graft of 1,2 intercompartmental supraretinacular artery (1.2 ICSRA) and subsequent osteosynthesis. Material and method. A retrospective study was performed on 10 male patients with a radiographic diagnosis of nonunion. Functionality, pain using Visual Analog Score (VAS), grip strength, patient satisfaction and reintroduction to working life, using QuickDASH and May specific wrist scales were assessed after the treatment. The integration of the graft was checked by radiography. Results. The mean follow-up was 31.4 months, and 90% of the questionnaires were satisfactory. The VAS decreased by 4.6 points and the flexor-extensor mobility gain was 5°. The total graft consolidation rate reached 40% in 5.5 months on average. Discussion. Several studies have demonstrated better results using vascularized bone graft versus non-vascularized. From the description by Zaidemberg in 1991, the vascularized graft with 1.2 ICSRA artery, distal radius, has been the most widely used for the treatment of scaphoid nonunion. Conclusions. Our results are comparable with the literature reviewed, thus using vascular graft of the 1.2 ICSRA and osteosynthesis with Herbert-type screw, may be an alternative treatment for proximal scaphoid nonunion, without collapse or significant deformity (AU)

[Results of treatment of scaphoid nonunion with microvascularized bone grafts of the 1, 2 intercompartmental supraretinacular artery and osteosynthesis]. / Resultados del tratamiento de seudoartrosis de escafoides con injerto microvascularizado de arteria 1,2 intercompartimental suprarretinacular y osteosíntesis.

OBJECTIVE: To analyze the results of treatment of scaphoid nonunion with questionable viability of the proximal fragment, but without significant deformity or collapse, using a vascularized bone graft of 1,2 intercompartmental supraretinacular artery (1.2 ICSRA) and subsequent osteosynthesis. MATERIAL AND METHOD: A retrospective study was performed on 10 male patients with a radiographic diagnosis of nonunion. Functionality, pain using Visual Analog Score (VAS), grip strength, patient satisfaction and reintroduction to working life, using QuickDASH and May specific wrist scales were assessed after the treatment. The integration of the graft was checked by radiography. RESULTS: The mean follow-up was 31.4 months, and 90% of the questionnaires were satisfactory. The VAS decreased by 4.6 points and the flexor-extensor mobility gain was 5°. The total graft consolidation rate reached 40% in 5.5 months on average. DISCUSSION: Several studies have demonstrated better results using vascularized bone graft versus non-vascularized. From the description by Zaidemberg in 1991, the vascularized graft with 1.2 ICSRA artery, distal radius, has been the most widely used for the treatment of scaphoid nonunion. CONCLUSIONS: Our results are comparable with the literature reviewed, thus using vascular graft of the 1.2 ICSRA and osteosynthesis with Herbert-type screw, may be an alternative treatment for proximal scaphoid nonunion, without collapse or significant deformity.