Avascular Necrosis Of The Scaphoid Research Articles

Treatment methods in idiopathic avascular necrosis of the scaphoid - review

IntroductionIdiopathic avascular necrosis (AVN) of the scaphoid is commonly known as Preiser’s disease (PD). It is a rare condition with symptoms such as pain, swelling around the scaphoid area and a reduced range of motion of the wrist. This condition occurs in the absence of an acute fracture or a fracture non-union. The disease can be diagnosed using classic radiology, magnetic resonance imaging or computed tomography. Treatment methods include surgical nad non-surgical procedures.AimMain aim of the paper was to summarize most recent knowledge about treatment methods in idiopathic AVN of the scaphoid.Material and methodsTo conduct this review, we searched the databases for articles about PD. We used keywords ‘Preiser disease’ and ‘idiopthic avascular necrosis scaphoid’. Our focus was on articles published in between 2017 and 2023, as we wanted to focus on most recent publications.Results and discussionMain goals of the treatment of PD are pain relief, improved hand grip strength, wider range of motion of the wrist and enhanced overall hand and wrist function. Implementing conservative management seems not to bring satisfactory results in patients with PD. Various surgical routines are the treatment of choice.ConclusionsStage I of the disease is the most likely treated with bone-grafting or currettage. Method of choice in stage II is vascularized bone graft, in stage III – proximal row carpectomy. Due to the rarity of the disease, there are no established recommendations regarding the treatment. Further studies are needed to extend the knowledge of the disease and potential methods of its management.

Vascularized pronator quadratus pedicled bone grafting versus iliac crest bone grafting in the treatment of scaphoid nonunion: a retrospective study

Background: Vascularized pronator quadratus pedicled bone grafting is a viable procedure for the treatment of scaphoid nonunion. However, its superiority over iliac crest bone grafting is unknown. In this study, we compare the union rate and outcomes of these procedures in the treatment of scaphoid nonunion. Methods: The medical profiles of the patients with scaphoid nonunion that were treated with either pronator quadratus pedicled bone grafting (n=23) or iliac crest bone grafting procedure (n=31) were retrospectively reviewed. Patients with avascular necrosis of the scaphoid and those with the involvement of the proximal pole were excluded. The outcome measures were the union rate and time, active wrist range of motion, pinch, and grip strength. Results: The mean age of the patients was 30±8.1 yr. Bony union was achieved in all patients of the study groups. The mean time to union was 9.1±2.8 wk in the pronator quadratus group and 8.7±3.5 wk in the iliac crest groups (P=0.14). The mean active flexion, extension, radial deviation, ulnar deviation, pinch, and grip strength of the involved wrist averaged 87.3%, 86.2%, 80.2%, 89.1%, 84.3%, and 85.6% of the contralateral wrist in the pronator quadratus group and 85.5%, 87%, 77.8%, 85.1%, 88.8%, and 87.8% of the contralateral wrist in the iliac crest group, respectively. These differences were not statistically significant. Conclusion: Pronator quadratus pedicled bone grafting provides a similar union rate and outcomes compared to the iliac crest bone grafting in the treatment of scaphoid nonunion. Level of Evidence: IV

Preiser's Disease-Current Concepts of Etiology and Management.

The term Preiser's disease typically is used to describe idiopathic avascular necrosis of the scaphoid, but there have been a number of putative etiologies considered. It is rare and the natural history is not fully understood. Management of the condition should be based on patient factors as well as the stage of disease with regard to the scaphoid and the surrounding wrist. This chapter appraises the available evidence and aims to provide the reader with a framework to manage this rare condition.

Preiser disease in a child before complete ossification of the scaphoid: a case report

BackgroundThe pathology of Preiser disease remains controversial, and treatment for Preiser disease has not yet been standardised. Preiser disease itself is rare, and although it can be found in children, its presentation is even rarer; therefore, the treatment of paediatric patients with Preiser disease is more unclear than adult cases.Case presentationA 10-year-old boy who complained of left wrist pain was diagnosed with Preiser disease from osteosclerosis and segmentation on plain radiography and computed tomography, and low signal intensity on both T1- and T2-weighted images on magnetic resonance imaging. Because the patient was a child whose scaphoid was immature and pre-ossified, we chose a conservative immobilisation treatment with a thumb spica cast followed by an orthosis. After 3 months of immobilisation, the distal pole of the scaphoid showed remodelling. One year after the initial visit, plain radiography showed remodelling of the whole scaphoid, although magnetic resonance T1-weighted image showed that the recovery of intensity change was only observed in the distal pole. Two years after the initial visit, both plain radiography and magnetic resonance imaging showed a normal appearance and 5 years after the initial visit; the scaphoid bone showed normal development.ConclusionsThis is the first case report of Preiser disease before complete ossification of the scaphoid; therefore, we cannot say anything definitive about the treatment strategy. However, our experience suggests that conservative treatment may provide a cure for Preiser disease in children with immature ossification of the scaphoid without carpal collapse.

Vascularized Bone Graft Based on First and Second Inter-Compartmental Supraretinacular Artery in the Treatment of Scaphoid Nonunion: Our Experience

Objective: We aimed to evaluate the results of using a First and Second Inter-Compartmental Supraretinacular Artery (1,2-ICSRA) based vascularized bone graft (VBG) when performing Herbert screw fixation in scaphoid nonunion. Methodology: This is a retrospective study from January 2017 to August 2020 with a total of 16 patients. All those aged<50 years, fracture <2 yrs old, no previous surgical intervention on the fracture, and stage 1 or 2 degenerative changes at the fracture site were included. Patients with avascular necrosis of the scaphoid were excluded. All patients were radiologically examined. Herbert screw fixation was done under general anesthesia and a wedge-shaped VBG from the radius was placed at the nonunion site. Results: There were 12 males and 4 females with a mean age of 30.25±8.88 years. Chronic wrist pain at rest was completely relieved in all patients while the pain with motion was markedly diminished in 10 and eliminated in two. The average range of motion, pinch, and grip strength of the wrist improved after surgery. Power assessment showed that the mean power before surgery was significantly raised from 67.50±5.83 to 95.06±4.45 Kgs (p=0.001). The mean intensity of pain before surgery i.e. 5.54±1.36 reduced to 2.25±0.78 (p<0.001). Conclusion: We found excellent results when used Herbert screws along with a 1,2-ICSRA based VBG in patients with scaphoid nonunion, where the union was achieved in all and significant improvement was seen when power and pain were assessed.

Avascular Necrosis of the Scaphoid-Preiser Disease: Outcomes of 39 Surgical Cases

There is no established treatment standard for patients with idiopathic avascular necrosis of the scaphoid, also known as Preiser Disease. We evaluated outcomes of operative interventions performed for patients diagnosed with Preiser Disease and assessed scaphoid morphology in the contralateral wrists. We performed a retrospective review of all patients undergoing surgery for Preiser disease between 1987 and 2019 at our institution. A total of 39 wrists in 38 patients were identified. The mean age was 37 years at the time of surgery, and the median follow-up time was 5.3 years. The patients were classified according to the Herbert and Kalainov classifications. Pre- and postoperative pain and functional outcomes were evaluated, and Mayo Wrist Scores were calculated. Reoperations for complications were recorded. Scaphoid shapes were assessed for wide/type 1 and slender/type 2 scaphoids in the contralateral unaffected wrist in patients with unilateral disease. Overall, pain and Mayo Wrist Scores improved, while flexion/extension decreased slightly and grip strength remained stable. In a comparison of the 2 main surgery groups, 17 wrists with a pedicled vascular bone graft and 12 wrists with salvage surgery (4-corner fusion/proximal row carpectomy) showed similar functional outcomes. Similar outcome scores were found regardless of preoperative Herbert or Kalainov classifications. Radiographic morphologic evaluation of the contralateral side determined that 4 of 8 patients had a slender scaphoid shape, which has been shown to have a more limited vascular network when compared to full scaphoids. A treatment algorithm of Preiser disease is lacking and the optimal surgical treatment remains controversial. Pedicled vascular bone grafts had similar functional outcomes as salvage procedures, but preserving the scaphoid was possible in 70% of the pedicled vascular bone graft cases. A slender scaphoid is potentially more common in patients with Preiser disease who undergo surgery. Therapeutic IV.

Clinical case of preiser disease, bilateral femoral head and humeral head osteonecrosis associated with chronic corticosteroid therapy

Osteonecrosis is a pathologic process that is associated with numerous conditions and therapeutic interventions. Most commonly the hip is involved but almost any bone can develop osteonecrosis. It can occur in the femoral head, but also affect the femoral condyles, humeral heads, proximal tibia, vertebrae, and small bones of the hand and foot. The most frequent etiological factors are trauma, alcoholism, and chronic corticosteroid therapy; the latter causing the most devastating form of osteonecrosis. Glucocorticoid-induced osteonecrosis is a known toxicity in pediatric and young adult patients treated for Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL). Osteonecrosis of the shoulders and weight-bearing joints of the lower extremities has emerged as a major adverse effect of modern ALL therapy. Pain in the absence of activity (ie, rest pain) occurs in approximately two-thirds of patients, and nocturnal pain occurs in one-third. MRI continues to be the gold standard for diagnosis in symptomatic and asymptomatic patients, especially in early-stage disease. Respectively to Preiser disease, this condition is a rare disease of unknown etiology characterized by Avascular Necrosis (AVN), also known as osteonecrosis, of the scaphoid bone and the clinical manifestations include insidious and progressive pain lasting from months to years, edema, loss of strength and reduced range of motion in the wrist. The treatment of non-traumatic osteonecrosis remains one of the most controversial subjects in the orthopedic literature. The purpose of this case report is to bring to attention osteonecrosis as a potential side effect of corticosteroid use in the pediatric population, as a delayed or missed diagnosis can lead to several joints destruction.

Buerger's Disease And Avascular Necrosis Of The Scaphoid

HISTORY: 58 year old right-hand dominant, who comes in today for evaluation of her right wrist. She awoke 1.5-2 years ago one morning with pain. Denies any trauma or falls. She saw her PCM for what was presumed to be carpal tunnel syndrome, and was supposed to be sent to a specialist; however, this did not happen. Not seen again until late July 2020 with another provider. She reports intermittent pain but predominantly stiffness and limited flexion of her wrist. Cannot lift objects heavier than a gallon of milk. Reports carpal tunnel surgery in the same wrist in 1985. Reports a 24 pack-year history and is actively trying to quit. PHYSICAL EXAMINATION: Examination revealed swelling overlying the distal radius. Flexion of the right wrist was limited to 10 degrees, and extension was limited to 45 degrees. She demonstrated normal function of the FDS/FDP/FHL tendons, along with all of her extensor tendons. Sensation to light touch was in-tact in the median, radial, and ulnar nerve distributions. DIFFERENTIAL DIAGNOSIS: 1. Avascular necrosis of the scaphoid 2. Severe osteoarthritis of the radioulnar joint 3. Scapholunate dissociation TEST AND RESULTS: XRay of the right wrist-Chronic scaphoid avascular necrosis. MRI of the right wrist without contrast 1. Fragmentation, flattening, and partial collapse of the sclerotic edematous scaphoid, with mild volar flexion, with possible chronic osteonecrosis. 2. Severe osteoarthritis at the radiocarpal joint with high-grade cartilage injury, synovitis, capsular sprain, and small volar ganglion cysts. 3. Chronic appearing scarring and degeneration of the scapholunate ligament and TFCC. 4. Mild tenosynovitis and mild tendinosis of the tendons within the first and second extensor compartments. FINAL/WORKING DIAGNOSIS: Avascular necrosis of the scaphoid as a result of Buerger's Disease TREATMENT AND OUTCOMES: 1. Smoking cessation 2. Celestone injection of the scaphoid by Ortho-Hand Surgery 3. Thumb spica splint 4. Follow-up as needed

Preiser’s disease or avascular osteonecrosis of the scaphoid: An updated literature review

Avascular necrosis of the scaphoid, often referred to as Preiser’s disease, is little known despite the scaphoid being the second most frequently involved location in avascular pathology of the carpal bones after the lunate (Kienböck’s disease). Nonetheless, very few cases have been reported in the medical literature over the last century. Its pathophysiology is not completely elucidated although the unique vascularization of the scaphoid and several risk factors seem to be recurrently incriminated. Two new classifications based on modern imaging have appeared in the last decade and are now considered essential supplements to Herbert and Lanzetta’s original radiographic classification. Because of the lack of formal treatment guidelines, a wide range of different treatments have been explored over time, contributing to the confusion around this pathology. Adding to this confusion, are the numerous terms used to designate the condition and lack of knowledge concerning its pathophysiology, risk factors, clinical and radiographic presentation. The aim of this review is therefore to explore and clarify Preiser’s disease in terms of history, terminology, pathophysiology, clinical considerations and imaging and to propose a simple updated treatment algorithm based on the results provided by a thorough review of literature (53 publications, 170 patients) since Georg Preiser’s original and controversial description in 1910.

Medial femoral trochlea flap reconstruction: Clinical outcomes and perspectives

We report our experience with use of the medial femoral trochlea (MFT) osteochondral flap for carpal applications. Outcomes of all patients treated with MFT flaps were reviewed. Healing, range of motion, grip strength, carpal alignment, pain, and complication data were collected. MFT flaps were performed on seven patients with a mean age of 26.1 (range, 17-42) years. Indications included scaphoid proximal pole nonunion (n = 3), Kienböck's disease (n = 3), and Preiser's disease (n = 1). The mean follow-up was 32.3 (range, 5-70) months. Union was achieved in five patients at a mean of 12 (range 6-22) weeks. All five patients had increased grip strength and absence of pain at follow-up. There were two failures due to graft resorption. The MFT osteochondral flap is a technically challenging yet powerful tool to replace the loss of both carpal articular cartilage and adjacent bone.

Four-corner fusion method using a bioabsorbable plate for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists: a case series study

BackgroundScaphoid excision and four-corner arthrodesis is an acceptable salvage procedure for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, since first popularized in the 1980s. We investigated the potential application of novel bioabsorbable plates and screws made of un-sintered hydroxyapatite/poly-L-lactide composite for the treatment of metacarpal fractures. We used this material for the fixation of four-corner fusions for SLAC or SNAC wrists commencing from April 2009. The purpose of this study was to clarify the controversy in the literature regarding the use of these plates.MethodsThe surgical procedures and clinical outcomes of four-corner fusions using a bioabsorbable (poly-L-lactic acid and hydroxyapatite) plate were reported. Ten patients (mean age, 59.2 years) with SLAC or SNAC wrists underwent fusions between April 2009 and June 2016. The primary diseases were scapholunate ligament injury, Preiser disease, and scaphoid pseudarthrosis. The mean postoperative follow-up period was 45.9 months (range, 12–86).ResultsIn all patients, bone union was achieved without dislocation or pain. The mean wrist flexion and extension arc improved from 78.5 degrees before surgery to 90.5 degrees after surgery. Mean grip strength improved from 51 to 69% after surgery, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score improved from 53.5 to 14.3. No complications such as infection, avascular swelling, or tendon adhesion were observed. This implant requires no removal of internal fixation devices, produces stable outcomes, and is an effective fusion technique.ConclusionsWe summarized the outcomes of four-corner arthrodesis using bioabsorbable plates. Satisfactory clinical results were shown, with no obvious complications. This novel plate also serves as a good alternative for patients who are allergic to metals. Furthermore, bioabsorbable plates are advantageous as they do not require removal.

4 corner arthrodesisを施行したPreiser病の1例

4 corner arthrodesisを施行したPreiser病の1例

Clinical outcomes of nonsurgical treatment for Preiser disease.

To elucidate whether nonsurgical treatment for Preiser disease is effective.Eight patients with Preiser disease (median age 59 [47–69] years) underwent nonsurgical treatment (median symptom-onset-to-treatment interval 8 [9–180] months). At presentation, 7 patients complained of constant pain and 1 of motion-related pain. Pain restricted wrist range of motion (median modified Mayo wrist score [MMWS] 17.5 [range 10–30]). Radiography revealed stages 1 to 3 disease (Herbert–Lanzetta classification). Median scapholunate angle was 62° (54°–75°), with 3 wrists suffering dorsal intercalated segment instability (DISI). Magnetic resonance imaging showed (Kalainov criteria) 4 stage 1 wrists (complete necrosis) and 4 stage 2 (incomplete necrosis). Two had concomitant Kienböck disease. All patients underwent nonsurgical treatment (ie, oral pain killer, immobilization, rest) and were monitored via radiographic and clinical evaluations. Scapholunate angles and the scaphoid area reduction ratio were calculated using radiography. Response criteria were the patients’ subjective and objective status. Endpoint was the time from start of non-surgical to surgical treatment.Immobilization lasting 0 to 24 months (median 1.8 months) did not relieve their symptoms. Follow-up radiography showed that the disease stage had progressed in 5 of 8 wrists, with 5 wrists having DISI. The median area reduction ratio of the scaphoid was 11% (4%–52%) on anteroposterior views and 4% (−23% to 17%) on lateral views. Compared with the contralateral wrist, the median wrist flexion-extension arc was 61% (50%–79%) and the median grip strength 39%. Median MMWS score was 17.5 (10–25) – poor in 6 of 8 patients. Surgery was thus necessary in all patients.Nonsurgical treatment for Preiser disease did not improve subjective or objective outcomes and did not prevent deterioration of radiographic findings.Type of study/level of evidence: Therapeutic, Level V.

Avascular Necrosis of the Scaphoid Preiser Disease.

No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology, classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previous trauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids as Herbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered and only two patients received surgical treatment. We found that chosen treatment is not associated with the severity of Herbert Lanzetta stage and the outcome is not influenced by chosen treatment.

Osteonecrosis of the Upper Extremity: MRI-Based Zonal Patterns and Differential Diagnosis.

Regarding the upper extremity, osteonecrosis can relate to the humeral head and to any carpal bone, most commonly the lunate (Kienböck's disease), scaphoid (Preiser's disease and nonunion), and capitate bone (osteonecrosis of the capitate head). In children and adolescents, osteochondrosis is an important differential diagnosis at the epiphyses. Appropriate imaging of osteonecrosis depends on knowledge about blood supply, biomechanical load, and bone repair mechanisms. Contrast-enhanced MRI (ceMRI) enables the differentiation of up to three mostly band-shaped zones: necrotic tissue (proximal), hypervascular repair tissue (intermediate), and viable bone (distal). To distinguish between necrotic and repair zones, intravenous gadolinium is recommended in MRI. Osteosclerosis and insufficiency fractures in early and intermediate stages as well as osteoarthritis in advanced stages are best depicted using high-resolution CT (HRCT). The combination of HRCT and ceMRI allows for exact classification of osteonecrosis regarding morphology and viability.

The Vascular Anatomy of the Scaphoid: New Discoveries Using Micro–Computed Tomography Imaging

The purpose of this study was to investigate the intraosseous vascular anatomy of the scaphoid using recent advances in micro-computed tomography (micro-CT) imaging and 3-dimensional reconstruction. We also studied the effect of scaphoid shape and screw position on the intraosseous vascular structure. Thirteen upper extremities were injected with a contrast agent. The scaphoid bones were extracted and scanned using a micro-CT scanner. The vascular impact of screw insertion at various axes through the scaphoid was calculated and compared using the generated 3-dimensional models. The specimens were 3-dimensionally-printed and the morphology was assessed according to bone dimensions. A relationship between the internal vascular patterns and these morphological features was determined. All specimens received vascular inflow from the dorsal ridge forming a vascular network that supplied an average of 83% of the bone's volume. This network was supplemented in 4 specimens with volar vessels entering at the waist. Another network was identified, created by vessels entering volarly at the tubercle, which supplied the remainder of the scaphoid. One specimen did not receive any vessels at the tubercle. With regards to screw placement, screws placed in the central axis were the least disruptive to the internal vascularity, followed by the antegrade (dorsal) insertion axis. Two morphological bone types were identified: type I or full scaphoids and type II or slender scaphoids. Type I possessed a more robust internal vascular network than type II scaphoids. This study identifies 2 distinct types of scaphoid morphology with 1 of them having a less robust blood supply, which may prove to be related to development of nonunion, avascular necrosis, or Preiser disease. Central axis and antegrade (dorsal) screw fixation may be least disruptive to the internal blood supply. Safer fixation of the scaphoid bone may be achieved by knowledge of intraosseous vascular patterns.

The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Background Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically. Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique. Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse ( n = 6), Preiser's disease ( n = 1), radioscaphoid ( n = 1), or capitolunar ( n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws. Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months. Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement. Level of Evidence This is a level IV, retrospective case series.

Closing Radial Wedge Osteotomy for Preiser Disease: Clinical Outcomes

To determine clinical outcomes of Preiser disease treated with closing radial wedge osteotomy (CRWO). Seven patients with Preiser disease underwent CRWO. Two wrists had stage 2 disease, 3 had stage 3, 2 had stage 4 (Herbert-Lanzetta classification). Magnetic resonance imaging (MRI) showed that 4 wrists had stage 1 and 3 had stage 2 indicating complete and incomplete necrosis, respectively (Kalainov criteria), before surgery. Two wrists had concomitant Kienböck disease. The range of motion (ROM) of the wrists was restricted owing to pain, and median Modified Mayo Wrist Score (MMWS) was 15 points. Patients were followed after surgery with radiography, MRI, and clinical evaluation (ROM, grip strength, MMWS). Radiolunate and scapholunate angles were calculated on lateral radiographs. Although there were no usual postoperative complications (eg, infection, neuropathy, distal radius nonunion), 1 patient had an extensor pollicis longus tendon rupture, and another experienced osteoarthritis with deterioration of the distal radioulnar joint. Final follow-up radiography showed that 2 wrists were stage 3, 5 were stage 5 (Herbert-Lanzetta classification). At 1 year after surgery, T1-weighted MRI showed that 2 of 6 wrists had improved from stage 1 to stage 2 (Kalainov criteria). At the final evaluation, 5 wrists had no pain, and 2 had only mild pain. Compared with the contralateral wrist, the median ROM was 80% in extension, 73% in flexion. Median grip strength was 71%, median MMWS was 75 points, and clinical results were good in 1 patient, fair in 5, and poor in1. Although follow-up radiography showed that the disease stage had progressed in 4 of 7 patients, wrist pain alleviation, retention of ROM, and improvement of grip strength were obtained. The CRWO may be an option for reducing wrist pain and retaining ROM of the wrist owing to Preiser disease. Therapeutic V.

Ulnar hemimelia in deformed left forearm treated with ilizarov fixator

Pedicle bone graft as primary procedure for treatment of scaphoid nonunion. Pedicle bone graft use in delayed and nonunion of fractures and avascular necrosis scaphoid fracture. The most common indications for Pedicle bone graft have been for scaphoid nonunion, lunatomalacia (Kienbock's disease), and osteonecrosis of the scaphoid (Preiser's disease). Advantages over non vascularized bone graft have been established. Pedicle bone graft provide improved blood flow, osteocyte preservation, and accelerated healing rates. Local pedicle VBGs are the most commonly used methods. They are technically less demanding than are free VBGs and are associated with less morbidity. In managing osteonecrosis, most surgeons would agree that VBG should be reserved for scaphoid nonunion with an intact cartilaginous shell and no collapse. In treating scaphoid pathology, indications for pedicle bone graft include fractures/nonunions with proximal pole avascular necrosis and/or small proximal pole fragments.

Results of pronator quadratus pedicle bone graft as primary procedure for treatment of scaphoid nonunion

Pedicle bone graft as primary procedure for treatment of scaphoid nonunion. Pedicle bone graft use in delayed and nonunion of fractures and avascular necrosis scaphoid fracture. The most common indications for Pedicle bone graft have been for scaphoid nonunion, lunatomalacia (Kienbock's disease), and osteonecrosis of the scaphoid (Preiser's disease). Advantages over non vascularized bone graft have been established. Pedicle bone graft provide improved blood flow, osteocyte preservation, and accelerated healing rates. Local pedicle VBGs are the most commonly used methods. They are technically less demanding than are free VBGs and are associated with less morbidity. In managing osteonecrosis, most surgeons would agree that VBG should be reserved for scaphoid nonunion with an intact cartilaginous shell and no collapse. In treating scaphoid pathology, indications for pedicle bone graft include fractures/nonunions with proximal pole avascular necrosis and/or small proximal pole fragments.