Scaphoid Waist Nonunions Treated with Illiac Crest or Vascularized Bone Grafts

Abstract

Introduction: We report the results of 57 cases of surgical treatment of traumatic scaphoid nonunion. And the differences between the three used techniques either with an iliac bone graft (19) or an vascularized graft from the palmar (15) or dorsal (23) side of the radius. Methods: Mean age of patients: 24.8 years. Twenty-four had developed proximal scaphoid pole avascular osteonecrosis (AVON). Operative technique was chosen based on vascularization, location of the fracture, prior failed operations, and availability of a pedicle. We evaluated results retrospectively and compared clinical, functional, and radiological outcomes. Results: There was union in 46 of the 57 cases (81%). No significant differences in rate of consolidation were found between the 3 treatment groups; the highest, 87%, resulted from treatment with a ventral Mathoulin graft. The greatest improvement in grip strength was found in the iliac crest group (from 70% to 91%). The minor one in the dorsal vascularized graft group (from 81% to 83%). Major improvement in ROM was found in the iliac-crest group from 105 preoperative to 130 postoperative in F/E. The minor improvement was in the group of dorsal vascularized grafts. Even if the improvement in ROM wasn't significant. Fifty of 57 patients returned to work after a median time of 13 weeks, without differences between the treatment-groups. Iliac crest grafts yielded major correction of preoperative angles. Conclusion: Iliac crest grafts afforded the best reconstructions and the best clinical results in grip strength and ROM, but in these cases there were better circumstances for good healing because of a better blood supply. The vascularized grafts allows a comparable consolidation rate and a similar outcome in the Mayo score, of more difficult cases with AVON. But shows less increase in ROM and grip strenght.