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Use of Vascularized Bone Graft with Nitinol Staples for Treatment of Non-Union of the Scaphoid
Mehdi N. Adham, MD1; Jordan C. Deschamps-Braly, MD2; Kevin Kunkel, MD3; Christine Adham1
1Hand Surgery, Southwest Orthopedic and Reconstructive Specialists, Oklahoma City, OK; 2Plastic Surgery, University of Oklahoma, Oklahoma City, OK; 3Plastic Surgery, Warren Clinic, Tulsa, OK

Background
Non-union of the scaphoid after fracture is still very challenging for the hand surgeon. Various fixation techniques have been used to improve results. Conventional bone graft with wedge or in-lay-graft techniques are not successful in all cases. Vascularized bone graft and better fixation technique can improve success rate. Memory shape alloys possess unique biochemical properties that make them of particular interest with use in treatment of scaphoid non-union especially for the use of bone graft.

Methods
This retrospective study was from 1999 to 2010, where we performed over 40 vascularized bone transfers from the distal radius for scaphoid non-union using the 1-2, inter-compartmental supra-retinacular pedicle for our vascularized bone graft. Nitinol staples with vascularized bone graft have been used in the last 27 cases. Results are measured in terms of Mayo wrist score, union rate, and complications.

Results
All patients had union with the exception of one patient. Of the 27 patients with complete follow up, all patients achieved union and were able to return to pre-injury work levels at full capacity. Twenty-one patients had “Excellent” Mayo wrist scores, while 2 had “Good” results, 3 “Satisfactory”, and 1 “Poor.” One patient, who was non-compliant, required removal of the staple and subsequent insertion of pins.

Conclusion
Outcomes of vascularized bone graft and fixation with Nitinol staples are better than conventional non-vascularized bone graft or vascularized bone graft with pin or compression screw fixation. The memory shape staple offers an advantage over the standard compression screws with improved ease of application especially with use of vascularized bone graft.


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