Scaphoid non-union: the role of vascularized grafting in recalcitrant non-unions of the scaphoid

J Hand Surg Br. 2006 Apr;31(2):185-90. doi: 10.1016/j.jhsb.2005.09.012. Epub 2005 Nov 2.

Abstract

Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-union were treated with vascularized pedicle bone grafting and supplementary corticocancellous grafting. Five had screw fixation and six were fixed with K-wires. The average age of the patients was 28 years, average duration of the non-union was 39 months and mean radiological follow-up was 32 months. There were no significant skeletal complications, although two patients developed neuromata. At review, only six of the 11 non-unions were united. Whilst this is a difficult clinical problem and achieving union is a formidable challenge, we believe that there is a role for such extensive surgery in order to achieve good postoperative function.

MeSH terms

  • Adult
  • Bone Screws*
  • Bone Transplantation / methods*
  • Bone Wires*
  • Female
  • Fracture Fixation, Internal / methods*
  • Fractures, Ununited / surgery*
  • Humans
  • Male
  • Middle Aged
  • Osteotomy*
  • Pseudarthrosis / etiology
  • Pseudarthrosis / surgery*
  • Radius / blood supply*
  • Radius / transplantation*
  • Retrospective Studies
  • Scaphoid Bone / blood supply*