PRONATOR QUADRATUS VASCULARIZED MUSCLE BONE PEDICLE GRAFT IN NONUNITED SCAPHOID FRACTURE WITH FIXATION

Abstract

Background: Left untreated, scaphoid nonunion can progress to carpal collapse and a predictable pattern of radiocarpal arthrosis. The goals of surgery for scaphoid nonunion include uniting the fracture and restoring carpal alignment. Objective: To assess the effect of pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation. Patients and Methods: The study was conducted on 20 patients with a history of scaphoid fracture since three months ago and no clinical or radiological signs of healing at Al-Azhar University Hospitals from January 2018 till February 2019. The patients underwent pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation. Results: The mean age of the studied cases was 34.27 ± 11.74 years and male predominance with all of the studied patients noted no complications wither early or late and returned to their previous level of activity. All the cases achieved bony union (100%) in a mean of 12.5 weeks. There was improvement in mean radiolunate and scapholunate angles. Average range of motion and modified Mayo score. There were no early complications of surgical site infection or sensory disturbances in the area of the radial nerve. There were also none late septic complications. No radiographic progression of arthritis was noted in any patient within the available follow-up time. All patients returned to their previous level of activity and satisfied with the late clinical and functional results. Conclusion: Volar vascularized bone grafts is an easy method and provides excellent results while needing no special equipment. Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.