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Management of scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone
Tsung-Ting Tsai1, En-Kai Chao, Yuan-Kun Tu
1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Background:
Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion or avascular necrosis. When pre-operative suggestion of avascular necrosis of the proximal pole is confirmed by intra-operative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended.
Methods:
Five patients with nonunion of scaphoid fractures associated with avascular necrosis based on results of radiography and further confirmed by magnetic resonance images and intra-operative findings were operatively managed with 1, 2 intercompartmental supraretinacular arterial (1, 2 ICSRA) vascularized bone graft combined with supplemental cancellous bone grafts from the radius. Follow-up periods were at least 18 months. The functional outcomes and radiographs were analyzed.
Results:
In four of the five patients, the nonunion sites united within 4 months after surgery. The other patient had a superficial pin tract infection and bone healing was complete 6 months after the operation. The functional results were good in all five patients.
Conclusion:
1, 2 ICSRA is superficial to the retinaculum and runs directly into the bony tubercle. It is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.