FUNCTIONAL RESULTS OF TREATMENT OF NONUNION SCAPHOID FRACTURES (COMPARISON BETWEEN VASCULARIZED AND NONVASCULARIZED BONE GRAFTING)

*Bashar Haddad, Safwan Youssef and Meen Saad

ABSTRACT

Background: Scaphoid fractures, accounting for a significant proportion of carpal fractures, carry a notable risk of non-union (approximately 10%) and avascular necrosis (AVN) of the proximal pole (around 3%), a complication linked to the bone's unique vascular supply. Both vascularized and non-vascularized bone grafting are used to address scaphoid non-union. Objective: Optimizing treatment for scaphoid non-union by comparing vascularized and non-vascularized bone grafting techniques to identify the optimal method for rapid union, return to function, and minimal complications. Materials and Methods: A prospective Comparative study at Tishreen University Hospital between 2023 and 2024, enrolled young patients presenting with scaphoid non-union who were surgically treated with either vascularized or non-vascularized bone grafting. The cohort was divided into two groups based on the grafting technique used: vascularized bone grafting versus non-vascularized bone grafting. Results: This study investigated 20 patients with scaphoid non-union (average age 25.50 years, 80% male) with 90% of injuries occurring on the dominant, right side. Avascular necrosis was present in 20% of patients. All vascularized bone grafts were performed using the Matti-Russe technique, while non-vascularized grafts utilized the Kawai & Yamamoto (60%) and Zeidemberg (40%) procedures. While no significant associations were found between graft type and patient sex, affected side, dominance, or surgery timing, the vascularized graft group was older and had a higher rate of avascular necrosis. Both groups demonstrated improved Mayo and Quick DASH index scores post-surgery, with the vascularized group exhibiting greater improvement. Notably, vascularized bone grafts showed a significantly faster union rate (12.4±0.8 months shorter) compared to non-vascularized bone grafts (14.46±0.6 months, p=0.0001). This faster union is likely due to the improved blood supply provided by vascularized grafts, which is critical for accelerating bone union and enhancing overall recovery. Conclusion: For non-unions not complicated by avascular necrosis, a non-vascularized bone graft is recommended as it is technically simpler and does not require special expertise. However, for scaphoid non-union complicated by avascular necrosis, a vascularized bone graft is the optimal treatment.

Keywords: Scaphoid nonunion, Vascularized bone graft, Nonvascularized bone graft, Functional outcome, Treatment.