J Korean Soc Surg Hand.  2012 Dec;17(4):159-165. 10.12790/jkssh.2012.17.4.159.

Treatment of Scaphoid Nonunions Using a Pronator Quadratus Pedicled Bone Graft

• Jang MS
• Seo YS

• KMID: 1425258
• DOI: http://doi.org/10.12790/jkssh.2012.17.4.159

Abstract

PURPOSE
This study was to evaluate the clinical results of the treatment of scaphoid nonunions using a pronator quadratus pedicled bone graft.
METHODS
Thirteen patients with a scaphoid nonunion were treated with pronator quadratus pedicled bone graft. The average age of the patients was 20.23 years (range: 19-22 years) and the minimum follow-up period was one year. In all patients, bone grafting was performed and screw was fixed by using a volar aspect of distal radius bone graft with pronator quadratus muscle.
RESULTS
All 13 patients showed radiographic union with the average union time of 10.8 weeks (range: 9-13 weeks). Flexion, extension, radial deviation and ulnar deviation of wrist joint improved compared to the preoperative condition (p<0.05). Postoperative scapholunate and radiolunate angle improved compared to the preoperative condition (p<0.05). Eleven patients (84.5%) showed excellent or good results according to Herbert and Fisher's score criteria of functional, subjective satisfaction and radiographic result.
CONCLUSION
Pronator quadratus pedicled bone grafting can be considered to be easily accessible technique on vascularized bone graft for osteosynthesis of scaphoid nonunions. It is proved to be effective for bone union, increased wrist joint motion.

Keyword

Scaphoid; Nonunion; Pronator quadrates pedicle bone graft

MeSH Terms

Bone Transplantation
Follow-Up Studies
Humans
Radius
Transplants
Wrist Joint

Figure

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  Fig. 1 (A) The pronator quadratus pedicled bone graft is obtained from styloid process of distal radius. Bone graft was inserted into the non-union site and fixed using Acutrack compression crew. (B, C, D) Intraoperative photographs show the surgical approach between the flexor carpi radialis and radial vessels, the graft after its detachment from the styloid process of the raidus and its insertion into the non-union site.

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  Fig. 2 A 21-year-old man underwent the osteosynthesis using pronator quadratus pedicled bone grafting. (A) Preoperative plain radiograph shows scaphoid waist non-union. (B) Preoperative computed tomography image shows sclerotic change of proximal fragment and osteophytes. (C) Postoperative X-ray. (D) At 9 weeks after operation, healing was achieved and clinical result was excellent.

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