Vascularized Pronator Quadratus Pedicled Bone Grafting Versus Iliac Crest Bone Grafting in the Treatment of Scaphoid Nonunion: a Retrospective Study

Background: Vascularized pronator quadratus pedicled bone grafting is a viable procedure for the treatment of scaphoid nonunion. However, its superiority over iliac crest bone grafting is unknown. In this study, we compare the union rate and outcomes of these procedures in the treatment of scaphoid nonunion. Methods: The medical profiles of the patients with scaphoid nonunion that were treated with either pronator quadratus pedicled bone grafting (n=23) or iliac crest bone grafting procedure (n=31) were retrospectively reviewed. Patients with avascular necrosis of the scaphoid and those with the involvement of the proximal pole were excluded. The outcome measures were the union rate and time, active wrist range of motion, pinch, and grip strength. Results: The mean age of the patients was 30±8.1 yr. Bony union was achieved in all patients of the study groups. The mean time to union was 9.1±2.8 wk in the pronator quadratus group and 8.7±3.5 wk in the iliac crest groups (P=0.14). The mean active flexion, extension, radial deviation, ulnar deviation, pinch, and grip strength of the involved wrist averaged 87.3%, 86.2%, 80.2%, 89.1%, 84.3%, and 85.6% of the contralateral wrist in the pronator quadratus group and 85.5%, 87%, 77.8%, 85.1%, 88.8%, and 87.8% of the contralateral wrist in the iliac crest group, respectively. These differences were not statistically significant. Conclusion: Pronator quadratus pedicled bone grafting provides a similar union rate and outcomes compared to the iliac crest bone grafting in the treatment of scaphoid nonunion. Level of Evidence: IV