Treatment of nonunion of the scaphoid with pronator quadratus pedicled bone graft

Background. We report our experience with the operative treatment of six ununited scaphoid fractures with pronator quadratus pedicle bone graft. Methods. We made a prospectively study between 2011-2013 upon six patients with ununited scaphoid fractures and treated with pronator quadratus pedicled bone graft and Herbert- screw (4) or Kirschner-wires fixation (2). There were recorded: age, sex, ethiology, the location of fracture, time from fracture to diagnosis of nonunion, initial treatment, type of fixation, time to union, range of wrist motion, subjective complains, complications, grip strength, Mayo clinical wrist score, duration until return to work. The radiological criterion for ossous union was trabeculation across the site of the fracture on all three radiographs. Results. The final evaluation was made using subjective and objective criteria, the patient satisfaction, chronic pain, active range of motion, grip strength and ability to work. All the 6 cases presented radiographic consolidation after an average of 9,8 weeks. The mean period of evaluation was 14 month. The range of motion of the affected wrist averaged 61° flexion, 59° extension, 13° radial deviation and 25° ulnar deviation compaired with an average of 73° flexion, 65° extension, 16° radial deviation and 29° ulnar deviation of the contralateral wrist. The grip strength showed an average of 39 kilograms-force on the operated site compaired with an average of 41 kilograms-force on the contralateral site. All the patients returned to work after an average of 17 months. The final results according to Mayo Clinic Wrist Score was excellent in 3 cases and good in 3 cases. Conclusions. The pronator quadratus vascularised bone graft procedure is technically easy, optimal because of his good structural integrity as well as a robust blood supply and can be harvested with minimal donor site morbidity.