الفهرس 
Introduction
SCAPHOID RECONSTRUCTIONOnly 14 pages are availabe for public view
 |  | from | 143 |  |  |
| | | from | 143 | | |
Abstract
The aim of this work was to evaluate the results of treatment of non united scaphoid fractures using a vascularised bone graft from the dorsal aspect of the radius based on a pedicle from 1,2 I.C.S.R artery
The material of this work consisted of 25 cases with non-united scaphoid fractures admitted to El-Hadrah Orthopedics and Traumatology University Hospital. All cases were treated by the use of a vascularised pedicle bone graft from the dorsal aspect of the radius based on the 1,2 ICSRA.
The age of the patients were ranged from 22 to 53 years with a mean of 31.02±5.65. Eleven patients were hard workers (44.0%), 9 light workers (36.0%) and 5 house wives (20.0%).
The injured wrist was on the dominant side in 16 patients (64.0%) and on the non dominant side in 9 patients (36.0%).
In 20 patients (80%) the mechanism of injury was fall from height, while 4 patients (16.0%) had road traffic accidents and in one patient the injury occurred during sports.
Nineteen patients (48.0%) had occasional pain, and 6 cases (24%) had persistent pain. In seventeen patients (68.0%) the site of the fracture was in the waist, in 7 (28.0%) it was in the proximal pole, and in one patient (4.0%) the site of fracture was in the distal pole. Seven patients (28.0%) had osteoarthritic changes, while the other 18 patients had no changes.
Fourteen patients (56.0%) were not treated before, 10 cases (40.0%) were treated by cast, and only one patient (4.0%) was treated by open reduction and internal fixation with k-wire and screw
The range of time lag was between 4–82 months with a mean of 32.1±12.66 months. The most frequent duration was 24-36 months
The mean healing time of scaphoid fractures ranged between 8-16 weeks with an average of 11 weeks. The patients were followed up for 6-24 months after fracture union with an average period of 9 months.
Twenty two patients (88%) were satisfied with the outcome of the procedure with improvement in daily functional activity, regardless the clinical or radiological union, and three cases (12%) were not satisfied with the results.
The scaphoid scoring system was used to evaluate the final outcome of surgery. Eighteen patients (72.0%) had satisfactory results: 12 were excellent, and 6 were good. On the other hand there were 7 cases with unsatisfactory results, 4 of them were fair and 3 were poor.
Fifteen patients had no pain (60%), 6 had occasional pain non affecting usual activity (24%), four patients had pain with some limitation of activites (16%), and non had persistent severe pain. All patients returned to their original work activities between 6-12 months.
Compared with the contralateral side, the postoperative grip strength averaged 95% whereas the average pre-operative grip strength was 62.0%.as measured with the jamar dynamometer. There was some difference between dominant and non dominant hands. The average grip strength of dominant hand was 98% of contralateal side. For the non-dominant hand, it was 86% of the contralateral side.
The pre-operative extension was 53.6±9.6, and increased significantly post operatively to 80.5±10.5. The mean pre-operative flexion ranged from 45 – 65 with a mean of 55.0±8.0. Post-operative flexion increased significantly to 81.3±8.9. Ulnar deviation ranged from 50 – 65 pre-operatively with a mean of 60.2±4.98, and increased significantly post operatively to 85.6±12.65.
The mean radial deviation ranged from 4