title: Surgical treatment of nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents.
abstract: BACKGROUND
  The purpose of this retrospective study was to examine the clinical and radiographic results of treatment of proximal scaphoid nonunion and avascular necrosis with vascularized bone graft from the distal part of the radius in adolescent patients.
  
  
  METHODS
  Between 1993 and 1996, three adolescents with a proximal scaphoid nonunion and avascular necrosis underwent vascularized bone-grafting and internal fixation. The mean age at the time of the fracture was 14.8 years (14.4, 14.6, and 15.3 years), and the mean time interval between the fracture and the surgery was 19.3 months (six, seventeen, and thirty-five months). We retrospectively reviewed all available clinical and radiographic data from the time of fracture to the time of the last follow-up. All patients were examined clinically and radiographically at the time of the review, at a mean of 5.5 years (five, five, and 6.5 years) after surgery.
  
  
  RESULTS
  All fractures healed at a mean of 3.4 months (2.75, 3.0, and 4.5 months) postoperatively. Final follow-up radiographs showed union and revascularization of the proximal part of the scaphoid with no evidence of degeneration of the radiocarpal joint. None of the patients had limiting pain or scapholunate instability demonstrated on physical or radiographic examination. Dorsiflexion and radial deviation of the affected wrist were decreased by a mean of 22 degrees (10 degrees, 22 degrees, and 35 degrees ) and 15 degrees (5 degrees, 20 degrees, and 20 degrees ), respectively, compared with those of the normal wrist.
  
  
  CONCLUSIONS
  Grafting with vascularized radial bone is an effective treatment, leading to union and good function, for nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts 02115, USA. peter.waters@tch.harvard.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waters
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000473:pathology / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000473:pathology* / Q000601:surgery*; D011859:Radiography; D011884:Radius / Q000637:transplantation; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014954:Wrist Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*