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Correcting the scaphoid humpback deformity with the 1,2 Intercompartmental Supraretinacular Artery based vascularized bone graft: A single centre experience
Adrian Battiston, MD
1; Omar Barasain, MD
1; Conne Lategan, MSc
2; Brandon J Ball, MD, FRCSC
1; Adil Ladak, MD, MSc, FRCSC
1; Hollie A Power, MD
1; Michael Morhart, MD, MSc, FRCSC
1; Matthew WT Curran, MD, MSc, FRCSC
11University of Alberta Division of Plastic Surgery, Edmonton, AB, Canada; 2University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
Introduction
Humpback deformity (HD) is a well-documented deformity seen in scaphoid nonunions whereby flexion of the distal scaphoid causes an apex dorsal angulation deformity. Scaphoid nonunions can also be associated with other deformities including dorsal intercalated segment instability (DISI). No consensus on the most effective surgical correction of humpback deformity of the scaphoid. A well described technique is the 1,2 Intercompartmental Supraretinacular Artery based vascularized bone graft (1,2-ICSRA). However, there are concerns about the technique's ability to correcting the scaphoid humpback deformity. Herein, we present a retrospective review of patients who have undergone this technique to examine its ability to improve radiographic parameters of humpback deformity and carpal deformity.
Methods
A retrospective chart review was performed of patients undergoing treatment of scaphoid non-union form January 2007 to June 2021. Patients were included if they received a 1,2-ICSRA and had pre-operative and post-operative imaging available for review. Two independent reviewers with prior established inter-rater reliability of >95% assessed preoperative and postoperative intrascaphoid angles and scapholunate angles for all included patients to identify HD and DISI. Statistical analysis was conducted using two tailed paired T tests to determine statistical significance in changes in pre and post operative imaging. HD was defined as an intrascaphoid angle of greater than or equal to 35 degrees. DISI was defined as a scapholunate angle of greater than 60 degrees.
Results
A total of 239 patients were included who underwent treatment with the 1,2-ICSRA and had pre and post-operative plain film images available for review using a methodology published in the literature. The average patient age was 33 +/- 10.4 and 88% were male. Mean preoperative and postoperative intrascaphoid angles were 44.2 +/- 8.6 degrees and 38.7 +/-8.3 degrees respectively with a mean reduction of 5.5 +/- 9.7 degrees (p-value <0.01). The mean preoperative and scapholunate angles were 47.2 +/- 9.3 degrees and 41.5 +/- 9.1degrees respectively with a mean reduction of 5.7 +/- 10.7 degrees (p-value <0.01).
Conclusions
The results of our study have shown that the use of the 1,2 ICSRA in scaphoid nonunion is an effective method in improving the intrascaphoid angle and thus correcting the humpback deformity of the scaphoid.
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