Fractures of the proximal scaphoid waist are more prone to nonunion than distal scaphoid fractures. Thirty-nine patients (five females, 34 males; mean age 31 years) who had operation for proximal scaphoid waist nonunion between 2017 and 2020 were retrospectively analysed. Patients received a free vascularized medial femoral condyle graft (Group 1: 18 patients) or distal radial bone graft based on a 1,2 intercompartmental supraretinacular artery pedicle (Group 2: 21 patients). In Group 1, union was achieved in 17 of 18 cases, with mean time to union of 13 weeks and mean operation time was 221 minutes. In Group 2, union was achieved in 19 of 21 cases, with mean time to union of 15 weeks and mean operation time was 100 minutes. The radiological and functional results of both groups were similar. We recommend a distal radial bone graft based on the 1,2 intercompartmental supraretinacular artery pedicle for proximal scaphoid waist nonunions since the operation is shorter, technically more manageable and requires less microsurgical experience.
AntoniouIKAthanaselisEDRountasC, et al.MR angiogram confirms sustained blood flow in 1, 2 ICSR artery of vascularized bone grafting in scaphoid nonunion treatment. Eur J Orthop Surg Traumatol. 2019, 29: 343–8.
2.
AroraRLutzMZimmermannRKrappingerDNiederwangerCGablMFree vascularised iliac bone graft for recalcitrant avascular nonunion of the scaphoid. J Bone Joint Surg Br. 2010, 92: 224–9.
3.
BorgesCSRuschelPHPignataroMBScaphoid reconstruction. Orthop Clin North Am. 2020, 51: 65–76.
4.
BürgerHKWindhoferCGagglAJHigginsJPVascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am. 2013, 38: 690–700.
5.
CavitACivanOCapkinSKaleliTOzcanliHOzdemirHTreatment of scaphoid nonunion with 1, 2 intercompartmental supraretinacular artery vascularized graft and compression screw fixation. Injury.. 2021, 52: 2307–13.
6.
ChangMABishopATMoranSLShinAYThe outcomes and complications of 1, 2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am. 2006, 31: 387–96.
7.
ChaudhryTUppalLPowerDCraigenMTanSScaphoid nonunion with poor prognostic factors: the role of the free medial femoral condyle vascularized bone graft. Hand (NY). 2017, 12: 135–9.
8.
DoiKOdaTSoo-HeongTNandaVFree vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am. 2000, 25: 507–19.
9.
DeCarloLTOn the meaning and use of kurtosis. Psychol Methods. 1997, 2: 292.
10.
FernandezDLEggliSNon-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting. J Bone Joint Surg Am. 1995, 77: 883–93.
11.
GroeneveldRAMeedenGMeasuring skewness and kurtosis. J R Stat Soc, Ser D Stat (Online). 1984, 33: 391–9.
12.
HerzbergGComtetJLinscheidRAmadioPCooneyWStalderJPerilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am. 1993, 18: 768–79.
13.
HircheCHeffingerCXiongL, et al.The 1, 2-intercompartmental supraretinacular artery vascularized bone graft for scaphoid nonunion: management and clinical outcome. J Hand Surg Am. 2014, 39: 423–9.
14.
HopkinsKDWeeksDLTests for normality and measures of skewness and kurtosis: their place in research reporting. Educ Psychol Meas. 1990, 50: 717–29.
15.
JeromeTJVenkatachalamIKumarNPostoperative three-dimensional high frequency power Doppler ultrasonography in scaphoid nonunions treated with vascularized bone grafts. J Hand Surg Eur .2019, 44: 428–30.
16.
JeromeTJPrabuRTerrenceTKBhalajiSShanmugasundaramB1,2 Intercompartmental supraretinacular artery-based vascularized graft for scaphoid nonunion with avascular necrosis. Cureus. 2020, 12: e11290.
17.
JohnsonNADiasJJScaphoid waist fracture displacement within 2 mm and most proximal pole fractures do not need surgical treatment. J Hand Surg Eur. 2021, 46: 1023–6.
18.
JonesDBJrBürgerHBishopATShinAYTreatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse: a comparison of two vascularized bone grafts. J Bone Joint Surg Am .2008, 90: 2616–25.
19.
JonesDBJrBürgerHBishopATShinAYTreatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse: surgical technique. J Bone Joint Surg Am2009, 91: 169–83.
20.
JonesDBJrMoranSLBishopATShinAYFree-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010, 125: 1176–84.
21.
KawaiHYamamotoKPronator quadratus pedicled bone graft for old scaphoid fractures. J Bone Joint Surg Br. 1988, 70: 829–31.
22.
KimJParkJWChungJJeong BaeKGongHSBaekGHNon-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis. J Hand Surg Eur. 2018, 43: 24–31.
23.
KorompiliasAVLykissasMGKostas-AgnantisIPGkiatasIBerisAEAn alternative graft fixation technique for scaphoid nonunions treated with vascular bone grafting. J Hand Surg Am. 2014, 39: 1308–12.
24.
KrimmerHManagement of acute fractures and nonunions of the proximal pole of the scaphoid. J Hand Surg Br. 2002, 27: 245–8.
25.
LarsonANBishopATShinAYFree medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis. Tech Hand Up Extrem Surg. 2007, 11: 246–58.
26.
LimTKKimHKKohKHLeeHIWooSJParkMJTreatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting. J Hand Surg Am. 2013, 38: 1906–12.e1.
27.
MalizosKNZachosVDailianaZH, et al.Scaphoid nonunions: management with vascularized bone grafts from the distal radius: a clinical and functional outcome study. Plast Reconstr Surg. 2007, 119: 1513–25.
28.
MerrellGAWolfeSWSladeJFIIITreatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am. 2002, 27: 685–91.
29.
MoorsJJAThe meaning of kurtosis: Darlington reexamined. Am Stat. 198640: 283–4.
30.
MorrisMSZhuAFOzerKLawtonJNProximal pole scaphoid nonunion reconstruction with 1, 2 intercompartmental supraretinacular artery vascularized graft and compression screw fixation. J Hand Surg Am. 2018, 43: 770. e1770.e8.
31.
OngHTanGChewWTreatment of scaphoid non-union with 1,2 intercompartmental supraretinacular artery (1, 2 ICSRA) vascularised graft. Singapore Med J. 2011, 52: 658–61.
32.
PapatheodorouLKPapadopoulosDVGraberMMSotereanosDGDorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis. Injury. 2021, 52: 3635–9.
33.
PulosNKollitzKMBishopATShinAYFree vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery. J Bone Joint Surg Am. 2018, 100: 1379–86.
34.
ShinAYBishopATPedicled vascularized bone grafts for disorders of the carpus: scaphoid nonunion and Kienböck's disease. J Am Acad Orthop Surg. 2002, 10: 210–6.
35.
ShinAYBishopATBergerRAVascularized pedicled bone grafts for disorders of the carpus. Tech Hand Up Extrem Surg. 1998, 2: 94–109.
SteinmannSPBishopATBergerRAUse of the 1, 2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion. J Hand Surg Am. 2002, 27: 391–401.
38.
StrawRDavisTDiasJScaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1, 2 intercompartmental supraretinacular branch of the radial artery. J Hand Surg Br. 2002, 27: 413–6.
39.
Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.
40.
WaitayawinyuTMcCallisterWVKatolikLISchlenkerJDTrumbleTEOutcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg Am. 2009, 34: 387–94.
41.
ZaidembergCSiebertJWAngrigianiCA new vascularized bone graft for scaphoid nonunion. J Hand Surg Am. 1991, 16: 474–8.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
