American Society for Peripheral Nerve

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The Outcomes, Complications and Operative Times of the 1,2 Intercompartmental Supraretinacular Artery Pedicled Vascularized Bone Graft for Treatment of Scaphoid Nonunions
Jessica L. Robb, MD; Michael J. Morhart, BSc, MSc, MD
Plastic Surgery, University of Alberta, Edmonton, AB, Canada

Introduction: Numerous methods of vascularized bone grafting have been proposed for the treatment of scaphoid nonunion. Most notable are the distal radius pedicle graft and the free vascularized medial femoral condyle graft. Although the latter has gained recent popularity, the pedicled graft has a shorter operative time, involves only one surgical team and utilizes a same site donor, which makes it a valuable treatment option. The treatment of choice at our institution is the 1,2-ICRA vascularized bone graft. The purpose of the study is to present the largest series of patients treated with a unique version of the 1,2 –ICRA based vascularized bone graft and to evaluate union rate, surgical times, and complications.

Materials and Methods: A retrospective review was conducted from 2003-2013 identifying 107 patients with scaphoid nonunion treated with 1,2- ICRA-based vascularized bone graft. A single surgeon performed a modified technique in which the vascularized bone graft is embedded directly into the fracture site and fixated with a headless compression screw. 96 male and 11 female patients, averaging 25 years of age were followed for an average of 5 years. Union was determined by bridging trabeculae on plain radiographs. Length of nonunion, previous treatment, operative times, complications and subsequent surgical procedures were recorded.

Results: The union rate was 98 of 107 (92%). 32 were fractures of the proximal pole and 64 were of the waist. The same technique was used in the humpback deformity when present. The average length of non-union was two and a half years, ranging from four months to fifteen years. 12 patients had prior internal fixation and 7 had failed attempts with non-vascularized bone grafting from the iliac crest. 9 patients did not achieve union and were treated with a salvage procedure. In 2003, the average operative time was approximately two hours and in 2013 the operative time has decreased to less than an hour. All were discharged home on the day of the surgery with oral analgesic.

Conclusions: The results of this investigation support the use of a simplified 1,2 ICRA vascularized bone graft in the treatment of scaphoid nonunion as it a successful union rate with a relatively short operative time, and negligible donor site morbidity.

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