Carpal Fractures -Scaphoid and Other Carpal Fractures-Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions

Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions

Pdf Summary

The study evaluated the outcomes of using a combination of volar scaphoid buttress plating and a pedicled vascularized bone graft for the treatment of symptomatic, recalcitrant scaphoid nonunions. The study included 9 patients with scaphoid waist nonunions that had failed prior treatment, had long durations of nonunion, avascular necrosis of the proximal pole, or significant bone loss. The patients underwent treatment with the novel technique, and postoperative follow-up ranged from 11 to 19 months. Computed tomography scans demonstrated union in 8 of the 9 cases. There were some complications, including one patient with a minor hematoma and one patient who required revision surgery because the scaphoid failed to unite. Three patients experienced problems with the plate, with one requiring plate removal and two experiencing symptomatic clicking likely necessitating future removal. Despite these complications, 8 of the 9 patients reported satisfaction with the procedure. QuickDash scores averaged 8.2. The study concluded that the technique of volar buttress plating and vascularized bone graft showed promising results with a high rate of union, consistent radiographic improvement, and symptomatic relief. The procedure can be performed with minimal donor site morbidity and offers a new alternative for challenging nonunions. However, the study had limitations, including its retrospective nature, small sample size, lack of a control group, and limited follow-up.

Keywords

volar scaphoid buttress plating

pedicled vascularized bone graft

symptomatic scaphoid nonunions

recalcitrant scaphoid nonunions

avascular necrosis

union

complications

satisfaction

QuickDash scores

radiographic improvement