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Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique

Background  Scaphoid nonunion with humpback deformity and avascular necrosis (AVN) is a challenging problem. Correction of dorsal intercalated segment instability (DISI) requires grafting of a large and hard vascularized bone segment onto the volar side of the scaphoid. Purposes  We have been treati...

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Autores principales: Kawasaki, Keikichi, Nemoto, Tetsuya, Kubo, Kazutoshi, Tomita, Kazunari, Inagaki, Katsunori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical Publishers, Inc. 2020
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708029/
https://www.ncbi.nlm.nih.gov/pubmed/33282540
http://dx.doi.org/10.1055/s-0040-1715800
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author Kawasaki, Keikichi
Nemoto, Tetsuya
Kubo, Kazutoshi
Tomita, Kazunari
Inagaki, Katsunori
author_facet Kawasaki, Keikichi
Nemoto, Tetsuya
Kubo, Kazutoshi
Tomita, Kazunari
Inagaki, Katsunori
author_sort Kawasaki, Keikichi
collection PubMed
description Background  Scaphoid nonunion with humpback deformity and avascular necrosis (AVN) is a challenging problem. Correction of dorsal intercalated segment instability (DISI) requires grafting of a large and hard vascularized bone segment onto the volar side of the scaphoid. Purposes  We have been treating the patients with one-incision vascularized bone grafting technique for scaphoid nonunion to improve blood supply and correct humpback deformity. We evaluated these cases retrospectively to the surgical efficacy of our procedure. Methods  We harvested vascularized bone from the dorsal side of the radius using the method by Zaidemberg et al and inserted the cortical aspect into the scaphoid volar side using a direct lateral approach. Totally, 11 patients (nine males andtwo females) with a mean age of 40 years were recruited for this study. The mean time from fracture to treatment was 6 years and 3 months. The mean preoperative radiolunate angle was 25 degrees. All the patients showed AVN of the proximal scaphoid on T1-weighted images. An averaged follow-up period was 2 years and 3 months. Results  Postoperative computed tomography revealed bony union in 10 patients (91% of union rate) with a mean modified Mayo'swrist score of 88 points (range, 75–100 points) and a mean disabilities of arm, shoulder, and hand (DASH) score of 4 points (range, 0–20 points). The mean radiolunate angle was corrected from 25 to 5 degrees. No adverse events were observed, except temporary mild paresthesia of the radial nerve territory in two patients. Conclusion  This technique effectively corrected DISI in patients with scaphoid nonunion accompanied by humpback deformity and AVN.
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spelling pubmed-77080292021-08-17 Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique Kawasaki, Keikichi Nemoto, Tetsuya Kubo, Kazutoshi Tomita, Kazunari Inagaki, Katsunori J Wrist Surg Background  Scaphoid nonunion with humpback deformity and avascular necrosis (AVN) is a challenging problem. Correction of dorsal intercalated segment instability (DISI) requires grafting of a large and hard vascularized bone segment onto the volar side of the scaphoid. Purposes  We have been treating the patients with one-incision vascularized bone grafting technique for scaphoid nonunion to improve blood supply and correct humpback deformity. We evaluated these cases retrospectively to the surgical efficacy of our procedure. Methods  We harvested vascularized bone from the dorsal side of the radius using the method by Zaidemberg et al and inserted the cortical aspect into the scaphoid volar side using a direct lateral approach. Totally, 11 patients (nine males andtwo females) with a mean age of 40 years were recruited for this study. The mean time from fracture to treatment was 6 years and 3 months. The mean preoperative radiolunate angle was 25 degrees. All the patients showed AVN of the proximal scaphoid on T1-weighted images. An averaged follow-up period was 2 years and 3 months. Results  Postoperative computed tomography revealed bony union in 10 patients (91% of union rate) with a mean modified Mayo'swrist score of 88 points (range, 75–100 points) and a mean disabilities of arm, shoulder, and hand (DASH) score of 4 points (range, 0–20 points). The mean radiolunate angle was corrected from 25 to 5 degrees. No adverse events were observed, except temporary mild paresthesia of the radial nerve territory in two patients. Conclusion  This technique effectively corrected DISI in patients with scaphoid nonunion accompanied by humpback deformity and AVN. Thieme Medical Publishers, Inc. 2020-12 2020-09-03 /pmc/articles/PMC7708029/ /pubmed/33282540 http://dx.doi.org/10.1055/s-0040-1715800 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Kawasaki, Keikichi
Nemoto, Tetsuya
Kubo, Kazutoshi
Tomita, Kazunari
Inagaki, Katsunori
Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title_full Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title_fullStr Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title_full_unstemmed Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title_short Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique
title_sort vascularized bone grafting for scaphoid nonunion with humpback deformity: the surgical technique
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708029/
https://www.ncbi.nlm.nih.gov/pubmed/33282540
http://dx.doi.org/10.1055/s-0040-1715800
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