Clinical and functional outcomes of 1,2 intercompartmantal supraretinakulary artery based vascularised bone graftin for schaphoid nonunion

Scaphoid fracture is the most common in the carpal bone fractures. Scaphoid acts an important role in the biomechanics of the wrist. Diagnosis and treatment is usually delayed. Due to local factors adversely affecting the union, especially displaced fractures of the waist region and the proximal pole nonunion is common. İf non-union untreated, can result in significant morbidity .The treatment of nonunion, in the presence of avascular necrosis success of conventional non-vascularized grafts decreases too much. Successful results of vascularized grafting in these situations, makes these techniques an appropriate treatment option for it.The purpose of this study was to evaluate clinical, radiological and functional outcomes of 1.2 intercompartmantal supraretinaculary artery ?based vascularized bone grafting with scaphoid nonunions who referred at Celal Bayar University, Department of Orthopedics and Traumatology.All patients were male ( n=20). Mean age was 26,4 (20-39). Mean follow up time was 33,5 (12-63) months. Avascular necrosis was present in 13 case (%65). Eleven patients (%55) had middle part nonunion and 9 patients (%45) had proximal pole nonunion.We achieved %85 union rate and scaphoid nonunions went on to union at an average of 11,4 weeks after surgery. Union rate was 76.9% in the presence of proximal pole avascular necrosis. In three patient we had treatment failure. Univariate risk factors for failure included proximal pole avascular necrosis, tobacco use, localization of fracture, smoking history, history of the application to us after the first injury, the implant type, age, preoperative higher DASH scores. There was no statistically significant effect on union and union time.Radiological evaluation; in accordance with the literature postoperative Natrass scapholunate angle and carpal height index showed a statistically significant improvement.Functional evaluation; postoperative DASH scores had a statistically significant improvement. Compared with contralateral side grip strength, pinch strength, wrist range of motion consistent with the literature were assessed as successful.İn this study we concluded that vascularized grafting technique including the patients with avascular necrosis, provided hıgh level union rates, obtained the positive effect on wrist alignment and provided high level improvement of wrist functions.In the cases with treatment failure, the patients with multipl risk factors tended to have more worse results. For better understanding these factors, multi-center prospective randomized studies are needed.Keywords: Scaphoid nonunion, treatment, vascularised bone greft, outcome