Reconstruction of the Irreparable Proximal Scaphoid with Costo-Osteochondral Graft (Rib Graft)

Abstract Background Irreparable proximal pole fractures of the scaphoid remain a real challenge for treating handsurgeon. Standard salvage options include 4-corner fusion or row carpectomy. These procedures limit range motion and have high rate conversion to total wrist fusion. The two current biological reconstructive are rib graft vascularized femoral trochlea osteocartilaginous free flap. In addition, there is prosthetic semi-replacement arthroplasty using pyrocarbon adaptive implant (APSI). Aims To present our series patients with non-reconstructable nonunion/fracture (not suitable conventional bone reconstruction) who were treated by technique. Methods Our case 21 between March 2013 January 2019 will been presented (median follow-up 29 months). surgical technique be described crucial technical steps explained. mean age at surgery was 26 years (SD 5.8) median time injury 2 (IQR 1.7–3.6). postoperative months 19.5–42.4). Results All returned their pre-surgical occupation. Significant differences found in active movements, grip strength, QuickDASH PRWE pain scores. Union seen all patients. capitolunate angles within normal limits. 17/21 showed no progessive osteoarthritic changes, while 4/21 slight progression. Progressive ossification noted 14 /21 No donor site complication occurred. One patient failed underwent excision fourcorner 9 after graft. At revision, clinically united. We statistically significant improvements PRWE. Conclusions results suggest that reconstruction irreparable nonunion costo-osteochondral (rib graft) reliable straightforward procedure this challenging problem.