[Treatment of scaphoid nonunion with bone flap pedicled on the recurrent branch of radial artery to the styloid process].

OBJECTIVE

To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion.

METHODS

From March 2000 to June 2005, the procedure was done in 18 patients with scaphoid nonunion, a small bone flap (1.5 cm x 3.5 cm x 0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients, among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degeneration at fracture end and obviously widening fracture line.

RESULTS

The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was 4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day.

CONCLUSION

Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.