A Method of Treating Scaphoid Nonunion by Applying Periosteal Flaps on Metacarpal Arteries

The purpose of the study: to improve the method of surgical treatment of patients with scaphoid nonunion.
Material and methods: the results of treatment of 30 patients operated on for scaphoid nonunion of the hand, which arose after conservative treatment (not treatment) of fractures, surgical treatment for 2018-2021 were analyzed.
The patients were divided into two groups: 15 patients with scaphoid nonunion who underwent free bone autoplasty as a surgical aid, fixation of bone fragments with a headless screw – a control group; 15 patients with fscaphoid nonunion, who underwent free bone autoplasty as surgical treatment, supplemented with non-free plastic surgery with a periosteal flap on the metacarpal artery – the main (experimental) group of patients. The possibility of using periosteal flaps isolated from the first and second metacarpal bones was evaluated.
To assess the results of treatment, X-ray monitoring of scaphoid nonunion consolidation was used at 8, 12 weeks and 6 months after surgery; computed tomography of wrist joints was performed at 4 months after surgery in order to assess the degree of bone graft reconstruction.
Hand function was assessed before and after surgery using the DASH Upper Limb Disability Questionnaire and the Visual Analog Pain Scale (VAS).
Results of the study: in the experimental group, scaphoid nonunion consolidation was achieved in 13 out of 15 patients (86.6%) compared with the control group (10 out of 15 patients – 66.7%).
According to the severity of the pain syndrome and the final functional result, comparable indicators were obtained in both groups.
Discussion: given the small sample of patients who participated in the work, the study has moderate reliability. However, the data obtained allow us to hope for the effectiveness of the proposed method of surgical treatment used in patients of the main study group.