A new study published in Injury evaluated the clinical, functional and radiological outcomes of 1,2-intercompartmental supraretinacular artery (1.2-ICSRA) vascularized graft technique together with compression screw fixation for the management of scaphoid nonunions.

This was a retrospective study that evaluated medical records of 21 patients treated with 1,2-ICSRA vascularized graft for established scaphoid nonunion of the waist or proximal pole from 2015-2018. Seventeen patients were selected; all were males with an age-range of 20-35 years. Radiological and clinical examinations were routinely performed 2 weeks, 6 weeks, and 3 and 6 months after surgery, as well as during the final follow-up. Postoperative clinical and functional outcomes at the latest follow-up were evaluated by measuring active wrist range of motion, grip strength, Turkish version of Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Quick DASH) and Mayo Wrist scores and comparing them with preoperative values.

It was found tha:

• The fracture site was at the scaphoid waist and proximal pole in 5 and 12 patients, respectively.
• Avascular necrosis was observed in 13 patients – 2 at the waist and 11 at the proximal pole.
• The mean follow-up duration was 18.88 ± 11.98 months. No graft extrusion was recorded and no other complication was observed.
• Overall, 15 (88.2%) patients achieved union.
• The total wrist motions of patients were better postoperatively than preoperatively, while only improvement in wrist extension was found to be statistically significant.
• Furthermore, Quick DASH and Mayo Wrist scores of the patients and grip strength were significantly improved postoperatively.

It was concluded that 1,2-ICSRA vascularized graft technique together with compression screw fixation offers an easy and reliable option for the treatment of scaphoid nonunions, with a high union rate and good functional and clinical outcomes.

Source: Injury. 2020 Feb 12. pii: S0020-1383(20)30112-1. doi: 10.1016/j.injury.2020.02.037.