Schapoid Nonunion Treated With Vascularized Pronator Quadratus Pedicled Bone Graft and Compression Headless Screw

A Case Report

Abstract

Introduction : The scaphoid is the most commonly fractured bone in the carpus and patients are often healthy young individuals. Non-union of scaphoid fractures are reported to occur in about 10% of cases.¹ Management options include bone graft techniques, screws, Kirschner wires and salvage procedures, with choice of treatment dependent on both patient and disease characteristics. Surgery has a reported failure rate of 25%–45%.

Case Presentation :A 17 year old male came to the polyclinic with the main complaint of pain on the right wrist which was felt since 1 year ago after falling during sports. After the fall, the patient experiences minimal pain so that the patient does not go to the doctor and is only treated with ice packs and taking pain medications A month after the fall, the patient finally checked his right wrist to the doctor, but the X-ray results did not show any abnormalities in the patient's wrist. Then patient underwent physiotherapy for 5 months. A year after the trauma, patient went back to the doctor and found a fracture in the wrist that had not yet fused. Patient is a high school student with dominant right hand. The history of massage was denied by the patient. On physical examination, there was no swelling, redness and deformity of the wrist. There was tenderness in the volar wrist and there was no disturbance of sensation. The range of motion of the wrist is limited due to pain. Patient already done vascularized bone graft with Herbert screw

Discussion :The treatment of scaphoid nonunion is still a challenge for hand surgeons. Nonunion rate of scaphoid fractures varies between 5% and 15%.¹ Due to tenuous retrograde blood supply of the scaphoid. The most prominent symptom of scaphoid nonunion is pain during wrist motion but if left untreated, it can cause osteoarthritis, decrease in grip strength and limitation in wrist range of motion. The aim of the treatment is to achieve union and restore normal carpal anatomy, stability and range of motion

Conclusion : In summary, this case further demonstrates that non-union schapoid fracture can be treated with vascularized bone graft and screw fixation as a primary intervention, despite the long duration to surgical management. Therefore in this specific patient group there is evidence that reconstruction should be considered before salvage procedures such as proximal row carpectomy and wrist fusion.

Keywords : Schapoid nonunion, Vascularized Bone Graft, Compression Headless Screw