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89th Annual Meeting Abstracts


Use of Vascularized Bone Graft with Nitinol Staples for Treatment of Non-Union of the Scaphoid
Jordan C. Deschamps-Braly, M.D.1, Mehdi N. Adham, MD1, Christine Adham, B.S.2.
1The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 2The University of Oklahoma, Norman, Oklahoma, OK, USA.

PURPOSE:
The non-union scaphoid fracture is still a challenging problem in hand surgery. The efficacy of standard compression style staples with use in scaphoid fractures has been established. Memory shape alloys possess unique biochemical properties that make them of particular interest with use in bone fixation. Conventional bone graph with wedge or in lay graph technique are successful in 70-90 % of scaphoid non-union. To improve the result and reduce the immobilization of vascularized bone graph technique from distal radius has been introduced for treatment of scaphoid non-union.
METHODS:
Between the years 1999 and 2009 we have performed over 30 vascularized bone transfers from the distal radius for scaphoid non-union. We use the 1-2, inter-compartemental supra-retinacular pedicle for our vascularized bone graft. Fixation initially consisted of screw fixation, however, we had difficulty stabilizing this construct and we turned to wire fixation thereafter. More recently, since 2005, we have achieved improved fixation using nitinol staples in the last 20 cases.
RESULTS:
All patient had union except one patient that was generally considered to be non-compliant with immobilization. One patient required removal of the staple and insertion of pins. All non-union scaphoid fractures ultimately healed and patients were able to return to pre injury work except for one patient.
CONCLUSION:
Outcomes of vascularized bone graft and fixation with Nitinol staples are superior to: conservative treatment, conventional non-vascularized bone graft or vascularized bone graft with pin fixation. The memory shape staple offers an advantage over the standard compression screws with improved ease of application specially with use of bone graft.


 

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