Pedicled distal-radius vascularized bone graft with shape-memory staple fixation for scaphoid nonunion: A modified technique

Scaphoid nonunion remains a challenging condition due to the scaphoid's retrograde vascular supply, its susceptibility to collapse, and the risk of progressive carpal malalignment and degenerative changes. Pedicled vascularized bone grafts harvested from the distal radius preserve intrinsic perfusion but require stable fixation to allow graft incorporation. This study describes a modified surgical technique combining a pedicled distal-radius vascularized bone graft based on the recurrent volar intercarpal artery with fixation using a shape-memory nitinol compression staple and reports early clinical and radiographic outcomes in a consecutive series. A retrospective analysis of 8 consecutive patients treated between January 2024 and January 2025 was performed. Clinical outcomes included wrist range of motion, pain assessed using a visual analog scale (VAS), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the Michigan Hand Outcomes Questionnaire (MHQ). Radiographic union was evaluated using standard radiographs and computed tomography (CT). Bony union was achieved in all patients (100%) by six months. Mean QuickDASH scores improved from 36 preoperatively to 6 at final follow-up, while mean MHQ scores improved from 60 to 91. Mean clinical follow-up was 7 months. No implant-related complications or donor-site morbidity were observed. This modified technique appears feasible and was associated with early radiographic union and functional improvement in this small retrospective series. However, these findings represent preliminary results, and larger comparative studies with longer follow-up are required to determine its long-term clinical effectiveness and potential advantages over established fixation methods.