Case trial biker with scaphoid non-union
I would appreciate if you could comment on this case and offer treatment options as to address his actual problem.
Man, 29 years old, right hand dominant, former world champion trial biking (9x), still in competition.
Fell on the 3/6/2012 while trial biking.
He sustained a nondisplaced scaphoid fracture to the left wrist and a nondisplaced radial head
fracture (left elbow).
(CBCT 1-3 in attachment)
I operated on him the 4/6/2012 (percuteanous screw osteosynthesis)
Uneventful immediate postoperative recovery with biking resumption mid July 2012.
(XR 6w 1-3 in attachment)
Patient became symptomatic by mid September after an intensive (asymptomatic) summer of high level competition and public demo/trials.
He came to my office today (5 months postop) complaining mainly of pain, loss of grip strength and loss of wrist extension impairing his biking skills.
(ROM right - left wrist extension/ flexion - radial/ulnar deviation:
R 64/0/74 28/58 - L 54/0/64 16/40)
(Jamar grip strength R 70 - L 40kg)
(XR 5m 1-5 & CBCT 5m 1-4 in attachment) (delayed/non-union with loosening screw distal part and loss of reduction)
He consented for a revision procedure but is eager to resume biking by early January.
I would be tempted by a vascularised bone graft (relying on the radial carpal artery as described by M. Haerle and C. Mathoulin) but am worried about his induced ROM restriction.
Any alternative options?
Regards to all,
Petrus Van Hoonacker (Belgium)