Vascularized bone grafting using the 1,2 intercompartmental supraretinacular artery for the treatment of Preiser's disease.

INTRODUCTION

Preiser's disease refers to a rare idiopathic avascular necrosis of the scaphoid that often leads to pole collapse and poor clinical outcomes when managed conservatively. Vascularized bone grafting (VBG) using the 1,2 intercompartmental supraretinacular artery (ICSRA) flap has been used to restore perfusion, but its treatment efficacy across different disease stages remains unclear.

METHODS

We retrospectively reviewed eight women (mean age 60.6 years) who were treated using 1,2 ICSRA VBG between 2006 and 2022. Disease stage was determined using the Herbert radiographic classification (one stage 1, four stage 2, and three stage 3 cases). Clinical parameters [grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Mayo Wrist Scores] and radiographic progression were assessed after a mean follow-up of 3.6 years. Contralateral scaphoid morphology was evaluated to explore any potential anatomical predisposition.

RESULTS

On average, there were improvements in grip strength (9.5 to 16.6 kg), dorsal flexion (49° to 65°), DASH score (49.5 to 10.6), and Mayo score in all cases. Radiographically, the stage 1 case did not exhibit any progression, one stage 2 case progressed, and all stage 3 cases progressed despite symptomatic improvement. Three patients exhibited type 2 scaphoid morphology, but no correlation with outcomes was observed.

CONCLUSION

VBG using the 1,2 ICSRA flap results in favorable clinical/radiographic outcomes in early Preiser's disease (stages 1-2), effectively preserving function and stability. In stage 3 disease, VBG may provide symptomatic relief but does not prevent progression. This warrants careful patient selection and consideration of alternative reconstructive options.