Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius.
Scaphoid nonunion with avascular necrosis of the proximal pole remains a difficult problem. We have endeavoured to heal the fracture, restore scaphoid height and revascularize the proximal pole of the scaphoid by means of a vascularized dorsal interposition graft from the distal radius. The procedure has resulted in union of six of ten fractures. Fractures that healed had not been treated by a previous bone grafting procedure. Dissatisfaction was due to loss of motion in patients who had healed fractures, and pain in those patients with persistent non-unions.
Boyer
M I
MI
Division of Orthopaedic Surgery, Sunnybrook Health Science Centre, Toronto, Canada.
von Schroeder
H P
HP
Axelrod
T S
TS
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods* / Q000473:pathology; D001864:Bone Wires; D002348:Carpal Bones / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D017534:Radial Artery / Q000637:transplantation; D011884:Radius / Q000098:blood supply / Q000601:surgery; D016059:Range of Motion, Articular; D012008:Recurrence; D014955:Wrist Joint / Q000503:physiopathology