Abstract
Introduction
Scaphoid nonunions (SN) are rare in adolescents. The use of vascularized bone grafts
(VBG) from the distal radius as an alternative to conventional grafting for the treatment
of established SN in adolescents is described.
Patients and Methods
The technique was applied in 13 patients with symptomatic SN resulting from fractures.
All patients were male with average age of 16.5 years (15–17.5). The average period
from injury to surgery was 8.3 months (4–13). Patients underwent vascularized bone
grafting and internal fixation with K-wires. In 6 patients with proximal pole nonunion
a VBG from the dorsal distal radius was used, and in 7 with a waist nonunion a VBG
from the palmar distal radius was used. The valuation was clinical (grip strength,
range of motion, VAS pain score, DASH) and radiographic. The time to return to activity
was also recorded.
Results
The mean follow-up was 9.8 years (range, 4–16). The union rate was 100% (11/11 cases).
Union was achieved in a mean period of 7.2 weeks (range, 6–10), without growth disturbance
or other complications from the epiphyseal plate of the distal radius. The range of
motion and grip strength was 89% and 92% of the contralateral respectively. The mean
postoperative DASH score was 8 and the VAS score was 1. All patients returned to daily
activities and sports in a mean period of 4.5 months.
Conclusions
The use of VBG from the distal radius provided a permanent solution in the rare case
of SN in adolescents, without donor site morbidity or epiphyseal plate disturbance.
The deformity and carpal height were corrected resulting in painless motion and grip
strength.
Keywords
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Article info
Publication history
Published online: October 21, 2019
Footnotes
☆This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
