Sarris I, Weiser R, and Sotereanos DG. Orthopaedics Division of Upper Extremity, Allegheny General Hospital, 320 E. North Ave., Suite 500, Pittsburgh, PA, USA
Purpose: To present a technically easier method for treatment of proximal pole non-unions of the scaphoid with vascularized bone graft. Materials and Methods: Eleven patients with wrist pain and limitation of motion were diagnosed as having scaphoid non-union of the proximal pole. The mean age was 32 years (range, 18-42), mean time from injury was 10 months (range, 7-12). Associated avascular necrosis of the proximal pole was observed in 5 patients by MRI scanning. No previous surgery was performed. We utilized a dorsal approach, the non-union was exposed and debrided. The insertion of the capsule proximally to the radius was identified and a distally based flap attached to a rectangular piece of corticocancellous bone of 1 cm2 was elevated. The tourniquet was released to ensure of bleeding from the bone graft and it was then impacted into the non-union site. The fracture was then securely fixed with a Herbert or Acutrax screw. The average follow-up was 30 months (range, 26-36). Results: Nine of the eleven patients returned to their previous activities. Nine patients were pain-free while one had mild pain after prolonged activity. One patient had persistent pain. Radiographic union was achieved in nine of eleven patients with an average time of 9 weeks. Flexion and extension arc was 80% (1400) of that of the contralateral wrist while grip strength and pinch strength improved in the nine healed patients. Conclusion: Based on our results, the technique of capsular distally based vascularized distal radius bone graft is a fairly simple technique compared to the Zeidenberg technique and is quite effective for the treatment of proximal pole scaphoid non-unions even with avascularity by MRI.