Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting.
Eleven patients who had an ununited fracture of the scaphoid associated with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay corticocancellous bone graft from the iliac crest and implantation of the second dorsal intermetacarpal artery, its accompanying venae comitantes, and a thin cuff of perivascular tissue. The absence of the blood supply to the proximal pole was evidenced both by radiographic changes--which included increased bone density, absence of normal trabeculae, and cystic changes--and by failure to observe bleeding bone during the operation. There were ten men and one woman. The average duration of non-union was fourteen months (range, six to thirty-three months). Six patients had had previous unsuccessful operative attempts to obtain union. Eight non-unions were in the proximal one-third and three, at the waist of the scaphoid. Union was achieved in ten patients at an average of ten weeks postoperatively. According to the wrist-scoring system of the Mayo Clinic, at an average of five years (range, 2.5 to eleven years), three patients had a grade of excellent; three, good; three, fair; and two, poor. Four patients had subsequent reconstructive procedures; radial styloidectomy, styloidectomy and resection of osteophytes, radioscapholunate arthrodesis, and total wrist arthrodesis were performed in one patient each.
Fernandez
D L
DL
Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland.
Eggli
S
S
D000328:Adult; D001158:Arteries / Q000637:transplantation; D016025:Bone Transplantation / Q000379:methods*; D002348:Carpal Bones / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation