J

Korean Soc Surg Hand. 2012 Dec;17(4):159-165. Korean.

Published online December 31, 2012. https://doi.org/10.12790/jkssh.2012.17.4.159

Copyright © 2012. The Korean Society for Surgery of the Hand

Treatment of Scaphoid Nonunions Using a Pronator Quadratus

Pedicled Bone Graft

Mun Suk Jang, 1 and Yu Seok Seo2

1Republic of Korea Air Force l8st Fighter Wing Medical Center, Gangneung, Korea.

2Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital,

Soonchunhyang University College of Medicine, Bucheon, Korea.

Correspondence to: Mun Suk Jang. Republic of Korea Air Force l8st Fighter Wing
Medical Center, 117 Wall Ho Pyong street, Hak dong, Gangneung 210-060, Korea. TEL:
+82-33-649-3602, FAX: +82-33-645-8026, Email: jjangdol13@hanmail.net

Received August 25, 2012; Revised November 04, 2012; Accepted November 19, 2012.

This is an Open Access article distributed under the terms of the Creative Commons
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/)
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Abstract
Purpose

This study was to evaluate the clinical results of the treatment of scaphoid nonunions
using a pronator quadratus pedicled bone graft.

Methods

Thirteen patients with a scaphoid nonunion were treated with pronator quadratus pedicled
bone graft. The average age of the patients was 20.23 years (range: 19-22 years) and the
minimum follow-up period was one year. In all patients, bone grafting was performed and
screw was fixed by using a volar aspect of distal radius bone graft with pronator quadratus
muscle.
Results

All 13 patients showed radiographic union with the average union time of 10.8 weeks
(range: 9-13 weeks). Flexion, extension, radial deviation and ulnar deviation of wrist joint
improved compared to the preoperative condition (p<0.05). Postoperative scapholunate
and radiolunate angle improved compared to the preoperative condition (p<0.05). Eleven
patients (84.5%) showed excellent or good results according to Herbert and Fisher’s score
criteria of functional, subjective satisfaction and radiographic result.

Conclusion

Pronator quadratus pedicled bone grafting can be considered to be easily accessible

technique on vascularized bone graft for osteosynthesis of scaphoid nonunions. It is
proved to be effective for bone union, increased wrist joint motion.

Keywords: Scaphoid; Nonunion; Pronator quadrates pedicle bone graft

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 Figure 1
(A) The pronator quadratus pedicled bone graft is obtained from styloid process of
distal radius. Bone graft was inserted into the non-union site and fixed using Acutrack
compression crew. (B, C, D) Intraoperative photographs show the surgical approach
between the flexor carpi radialis and radial vessels, the graft after its detachment from
the styloid process of the raidus and its insertion into the non-union site.

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 Figure 2
A 21-year-old man underwent the osteosynthesis using pronator quadratus pedicled
bone grafting. (A) Preoperative plain radiograph shows scaphoid waist non-union. (B)
Preoperative computed tomography image shows sclerotic change of proximal
fragment and osteophytes. (C) Postoperative X-ray. (D) At 9 weeks after operation,
healing was achieved and clinical result was excellent.

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 Table 1
Demographic data

AVN: avascular necrosis.

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 Table 2
Herbert and Fisher’s score

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 Table 3
Comparison of postoperative and preoperative values

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 Table 4
The Overall results
of pronator quadrates
pedicle bone graft of
non-uinon scaphoid
fracture (Herbert and
Fisher’s score)

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