Comparison of the outcomes of vascularized and nonvascularized bone grafting in treatment of scaphoid nonunion

Abstract

Background and Objectives: Scaphoid fractures are common fractures of the upper extremity and more than 5% of them progress to nonunion. Nonvascularized bone grafting (NVBG) and vascularized bone grafting (VBG) are used to treat this fracture and the best option for the treatment of scaphoid nonunion (SN) is controversial. Hence, this study aimed to compare the clinical outcomes of VBG and NVBG in treatment of SN. Materials and Methods: This quasi-experimental study was conducted on 30 patients with SN. The patients were divided into two groups of NVBG (n = 15) and VBG (n = 13) and were followed up at 2, 4, 8 weeks, and at least 10 months after surgery. Patients' functional abilities in both groups were compared using the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and the Mayo modified wrist score. Severity of pain was also compared using the Visual Analog Scale (VAS) before and after the surgery. Results: Union rates between the VBG (92.3%) and NVBG (73.3%) groups were not significantly different (P = 0.1). There was a significant difference in the VAS score (P = 0.03) and grip strength (P = 0.010) between the two groups. However, no significant difference was found regarding the active range of motion between the groups (P = 0.2). The postoperative Quick DASH scores of the VBG and of NVBG groups were 5.6 ± 1.1 and 8.4 ± 2.3, respectively, and the difference was significant (P = 0.001). The functional improvement based on the postoperative Mayo score was significantly higher in the VBG group compared with the NVBG group (85.9 ± 3.04 vs. 80.4 ± 6.6; P = 0.006). Conclusion: Vascularized bone grafting seems to be a preferable treatment option for SN because of its higher union rate and better functional outcomes.