Maniglio M, Schweizer A and Nagy L
We present the results of a retrospective study looking at postoperative outcomes of treatment of scaphoid nonunions following three different techniques: Palmar (nonvascularized) iliac crest, vascularized bone-grafts dorsal and palmar. The purpose is to present the consolidation rates and discover if range of motion, grip strength and pain differ using the different grafts.
Methods: We evaluated 57 cases with a mean follow-up of 6.6 months. 24 patients had nonunion of the proximal scaphoid pole with avascular osteonecrosis. Operative technique were chosen based on the vascularity, location of non-union, previous operations, and pedicle availability. Conventional graft was used in 19 patients, palmar vascularized in 15 and dorsal vascularized graft in 23. We measured and compared clinical and radiological outcomes.
Results: Out of 57 nonunions 46 united. No significant difference in rate of consolidation was found between the 3 treatment groups. Highest percentage of consolidation, 87%, was in patients treated with a palmar vascularized graft, whereas the consolidation rate of dorsal vascularized graft was 78% and of iliac crest graft 79%. Grip strength improved significantly. The most in iliac crest group (from 70% to 91%) and the least in dorsal vascularized graft group (from 81% to 83%). Best range of motion in flexion/-extension was in the iliac-crest group, although not being significantly. Average Mayo score was 82. 18 patients showed an excellent, 17 a good, 13 a satisfactory and 3 a poor result. No significant difference was found between the groups.
Conclusion: Vascularized grafts had a comparable consolidation rate and outcome in Mayo score as the iliac crest group, even though these cases were more problematic due to the presence of avascular necrosis. Iliac crest grafts afforded the best results concerning grip strength and range of motion. The gain in grip strength and range of motion was less with vascularized grafts.
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