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Background: The management of proximal pole nonunions of scaphoid with avascular necrosis remains the most controversial of all scaphoid fracture nonunions. Various types of vascularised bone grafts have been used to hasten union. We studied the union rate, clinical and functional outcome of 1, 2 intercompartmental supraretinacular arterial bone graft (1, 2 ICSRA) and radial styloidectomy for proximal pole scaphoid nonunion with avascular necrosis. Methods: We retrospectively analysed the four year outcome of vascularised distal radius bone graft (1, 2 ICSRA) and radial styloidectomy in 20 patients treated at our institution for proximal pole scaphoid nonunion with avascular necrosis between 2010 and 2014. Majority of cases (10) presented as failure of adequate immobilization. The average time to surgery from trauma was 14 months and mean duration of follow up was 30 months. Twelve (12) cases had features of early radioscaphoid arthritis. Nonunion and avascular necrosis were confirmed in all cases with radiographs and MRI scan. We followed the technique described by Zaidemberg et al for harvesting the vascualrised bone grafting from the distal radius. Results: Majority of the cases (80%) united by 20 weeks. There was significant improvement in the grip strength and pain postoperatively. Wrist flexion-extension and radial-ulnar deviation arcs improved but was not statistically significant. The Mayo Wrist Score showed 75 percent of patients had an excellent or good outcome. The scapholunate angle also improved from 62.5 deg to 46.5 deg postoperatively. Radiographic union was achieved in sixteen cases (80%) by 20 weeks. Three cases (15%) went for delayed union and achieved bony healing by thirty weeks. One case (5%) developed pintract infecton and progressed to radioscaphoid arthritis. Conclusions: Our study highlights the efficacy of 1,2 ICSRA vascualrised distal radius bone grafting in proximal pole scaphoid nonunions with avascualr necrosis in achieving good union rate with acceptable clinical and functional outcome in this difficult problem. This procedure can be done under regional block without the need for microsurgical set up and costly implants. Vascularised distal radius grafts with radial styloidectiomy is a promising solution for scaphoid proximal nonunions with avascular and early radioscaphoid arthritic changes.

international journal of orthopaedics sciences

The management of proximal pole scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone graft and radial styloidectomy: A midterm outcome study