Effect of bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in treatment of scaphoid fracture nonunion

SHEN Qiang; ZHANG Xu; YANG Xiaoliang; YU Yadong; WU Fan; DU Ze

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Medical Journal of the Chinese People Armed Police Forces ›› 2024, Vol. 35 ›› Issue (5) : 369-373.

Effect of bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in treatment of scaphoid fracture nonunion

SHEN Qiang¹, ZHANG Xu², YANG Xiaoliang², YU Yadong², WU Fan¹, DU Ze¹

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Abstract

Objective To investigate the clinical effect of the bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in the treatment of scaphoid fracture nonunion. Methods The clinical data of 32 patients with nonunion scaphoid bone fracture admitted to the Third Hospital of Hebei Medical University and Hebei Provincial Corps Hospital of Chinese People’s Armed Police Force from April 2015 to December 2021 were retrospectively analyzed. All patients were treated with the dorsal base bone flap of the second metacarpal bone with blood supply, which was based on the second communicating branch between the middle and distal arterial arch of the dorsal wrist. The operative parameters of the patients were recorded, and the range of motion of the wrist joint after operation was measured by the goniometer and compared with the measured values recorded before operation. The visual analogue Scale was used to assess wrist pain index and the Mayo wrist score was used to assess postoperative wrist function. Results All the 32 patients were successfully operated. The average size of bone flap was 11 mm×6 mm×5 mm and the average pedicle length was 16 mm. The bone healing time was 8-16 weeks (average 10 weeks). The average follow-up was 30 months (26-37 months). The mean navicular angle after operation was 13°(-4°-16°), which was significantly better than that before operation 28°(21°- 36°), and the difference was statistically significant (P<0.05). The mean radial angle of 10° was also significantly better than that of 17° before surgery, and the difference was statistically significant (P<0.05). Compared with the preoperative results, the mean height of CT coronal surface and the Mayo score of wrist joint function were also significantly better after operation. Conclusions The use of the second metacarpal dorsal base bone flap pedicled with the second communicating branch between the dorsal middle and distal arterial arches of the wrist is effective in the treatment of scaphoid fracture nonunion.

Key words

dorsal wrist middle and distal arterial arch / the second communicating branch / dorsal base of the second metacarpal / scaphoid / pedicle bone flap

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SHEN Qiang, ZHANG Xu, YANG Xiaoliang, YU Yadong, WU Fan, DU Ze. Effect of bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in treatment of scaphoid fracture nonunion[J]. Medical Journal of the Chinese People Armed Police Forces. 2024, 35(5): 369-373

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