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Surgical Treatment of Nonunion and Avascular Necrosis of the Proximal Part of the Scaphoid in Adolescents

Investigation performed at the Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts

Peter M. Waters, MD
Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address: peter.waters{at}tch.harvard.edu

Susan L. Stewart, MD
Department of Orthopaedics, Massachusetts General Hospital, GRB 624, 55 Fruit Street, Boston, MA 02114. E-mail address: sstewart1@partners.org

No benefits in any form have been received or will be received from a commerical party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Background: The purpose of this retrospective study was to examine the clinical and radiographic results of treatment of proximal scaphoid nonunion and avascular necrosis with vascularized bone graft from the distal part of the radius in adolescent patients.

Methods: Between 1993 and 1996, three adolescents with a proximal scaphoid nonunion and avascular necrosis underwent vascularized bone-grafting and internal fixation. The mean age at the time of the fracture was 14.8 years (14.4, 14.6, and 15.3 years), and the mean time interval between the fracture and the surgery was 19.3 months (six, seventeen, and thirty-five months). We retrospectively reviewed all available clinical and radiographic data from the time of fracture to the time of the last follow-up. All patients were examined clinically and radiographically at the time of the review, at a mean of 5.5 years (five, five, and 6.5 years) after surgery.

Results: All fractures healed at a mean of 3.4 months (2.75, 3.0, and 4.5 months) postoperatively. Final follow-up radiographs showed union and revascularization of the proximal part of the scaphoid with no evidence of degeneration of the radiocarpal joint. None of the patients had limiting pain or scapholunate instability demonstrated on physical or radiographic examination. Dorsiflexion and radial deviation of the affected wrist were decreased by a mean of 22° (10°, 22°, and 35°) and 15° (5°, 20°, and 20°), respectively, compared with those of the normal wrist.

Conclusion: Grafting with vascularized radial bone is an effective treatment, leading to union and good function, for nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents.

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