Comparison of two kinds of bone flap transplantation for treatment of old scaphoid fracture

Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture. Methods From June 2009 to June 2015, a total of 49 patients with old scaphoid fracture were retrospectively reviewed. 22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery, while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery. The operation time, fracture healing time and wrist function were compared between the two groups. Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P<0.001). However, the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P<0.001). Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery. In the radial styloid bone flap group, the results were excellent in 12 cases, good in 9 cases, and fair in 1 case with the average score being 87. In the descending genicular artery bone flap group, the results were excellent in 12 cases, good in 13 cases, fair in 1 case, and poor in 1 case with the average score being 81. There was no significant difference between the two groups. Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture. The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing, but more time-consuming and demanding. Key words: Scaphoid bone; Fractures,ununited; Vascularized bone flap