Capsular Vascularized Distal Radius Bone Grafting for Proximal Pole Nonunions of the Scaphoid

ABSTRACT

A technically easier method is presented for treatment of proximal pole nonunions of the scaphoid with vascularized bone graft.

Eleven patients with wrist pain and motion limitation were diagnosed as having scaphoid nonunion of the proximal pole. Mean patient age was 32 years (range: 18-42 years), and mean time from injury was 10 months (range: 7-12 months). Associated avascular necrosis of the proximal pole was observed in five patients by magnetic resonance imaging (MRI). No previous surgery was performed.

Through a dorsal approach, the nonunion 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 bleeding from the bone graft and it was impacted into the nonunion site. The fracture was then securely fixed with a Herbert or Acutrax screw. Average follow-up was 30 months (range: 26-36 months).

Nine of 11 patients returned to their previous activities. Nine patients were pain-free whereas 1 had mild pain after prolonged activity. One patient had persistent pain. Radiographic union was achieved in 9 of 11 patients within an average 9 weeks. Flexion and extension arc was 80% (1400) of that of the contralateral wrist whereas grip strength and pinch strength improved in the 9 healed patients.

Based on our results, capsular distally based vascularized distal radius bone graft is a simple technique compared to the Zeidenberg technique and is effective for the treatment of proximal pole scaphoid nonunions even with avascularity by MRI.