Bones non unions due to unfused fractures may result in pseudarthrosis pictures if they are not treated in time. In the upper limb, scaphoid fractures are at risk of becoming scaphoid pseudarthrosis, with the possibility of ending up in a surgical fixation of the wrist, and the corresponding loss of mobility and function, if not addressed appropriately.
In this clinical case the patient, 18 year old, comes to the clinic of Dr. Del Piñal with a scaphoid fracture already operated, which -as the non union persisted after the procedure- has resulted in a situation of pseudarthrosis. Pain and certain function difficulties acted as alarm signals.
The problem
The scaphoid pseudarthrosis causes pain and functional disturbances in the patient, with the risk of becoming a permanent picture if there is no intervention. The deffect, of no more than 0.8 cm., has a very significant impact however.
The objectives
The goals of the surgical unit of Dr. Del Piñal are fundamentally four: reverse the impaired functional mechanics to avoid an arthritic wrist, eliminate pain, restore mobility of the affected area and minimize the aesthetic impact of the procedure.
The plan
Dr. Del Piñal outlines a microsurgical approach based on the realization of a vascularized bone graft taken from the internal face of the patient’s own femur. This fragment will have to return the flow to the damaged area by reconnecting arteries and veins through the application of microsurgical techniques.
In turn, the insertion of a surgical screw helps stabilize the grafted material, facilitating the scaphoid to heal.
The outcome
After 6 hours in the operating room, the result of the procedure is successful. The patient needs 8 weeks of immobilization with plaster, for a total of 3-month recovery period.