Treatment of Nonunion of Proximal Scaphoid Fractures Using Vascularized Bone Graft

Abstract

Purpose: To evaluate the radiographic and clinical results of the treatment of nonunion of scaphoid proximal fractures using vascularized bone graft and internal fixation, and to present the surgical procedures in detail. Materials and Methods: Six patients with established nonunion of scaphoid proximal fractures who had been treated by vascularized bone graft and internal fixation from the year of 2000 to 2003 were analyzed retrospectively. The mean ages were 27.8 years old (18-45) and all the patients were male. The average follow upperiod was 13 months (8-18), and the causes of injuries were fall down in 4 cases, and motor vehicle accident in 2 cases. The 1,2-intercomparmental supraretinacular artery was used as a vascular pedicle for the bone graft and fixed with a Herbert screw. Results: All the non-unions had united at a mean period of 8.7weeks (7-11). According to the Maudsley and Chen s criteria, 4 and2 cases showed excellent and good results, respectively. There was one case of dysesthesia on the superficial branch of the radial nerve after surgery, which was resolved in2 months. Conclusion: A vascularized bone graft is an useful method for treating a nonunion of scaphoid proximal fractures without severe arthritic changes, and can achieve a shorter immobilization and improved bone healing.