Clinical Outcomes of Pedicled Vascularized Bone Grafting for Scaphoid Nonunion.

BACKGROUND: Scaphoid nonunion remains a challenging condition, particularly in the presence of compromised vascularity. Pedicled vascularized bone grafts preserve graft blood supply without microsurgical anastomosis and are widely used in this setting.

METHODS: A retrospective review was conducted of 30 consecutive patients treated with pedicled vascularized bone grafting for scaphoid nonunion between January 2021 and January 2023. Dorsal 1,2 intercompartmental supraretinacular artery grafts were used for proximal pole nonunion, while volar radial pedicled grafts were used for waist nonunion. Outcomes assessed included Mayo Wrist Score (MWS), Visual Analog Scale (VAS) pain score, grip strength, and wrist range of motion. Union was evaluated clinically and radiographically.

RESULTS: All patients demonstrated significant improvement in pain, wrist motion, grip strength, and functional outcome scores. Mean MWS improved from 51.47 ± 6.40 to 72.13 ± 5.76 (P < .001), while mean VAS pain scores decreased from 4.40 ± 0.50 to 2.03 ± 0.49 (P < .001). No patient demonstrated persistent nonunion or required revision surgery. Functional outcomes were comparable between dorsal and volar graft techniques.

CONCLUSION: Pedicled vascularized bone grafting provides reliable union and functional recovery in scaphoid nonunion. Comparable outcomes between techniques support graft selection based on fracture location and vascular considerations.