title: Thumb metacarpal vascularized bone graft in long-standing scaphoid nonunion--a useful graft via dorsal or palmar approach: a cohort study of 24 patients.
abstract: OBJECTIVE
  Long-standing scaphoid nonunion preferentially is treated by using a vascularized bone graft because of its superiority in achieving bone healing. In the present study nonunion was repaired using a bone graft raised from the thumb metacarpal and vascularized by the first dorsal metacarpal artery.
  
  
  METHODS
  Twenty-four patients with scaphoid nonunion for longer than 5 years, without ligament injuries and panarthrosis, had surgery. According to the location of the nonunion and presence of dorsal intercalated segment instability deformity, surgery was performed by either a dorsal or palmar approach. The patients had a final clinical and radiographic evaluation 12 months after surgery.
  
  
  RESULTS
  Complete healing was shown in 21 patients but incomplete healing was observed in the remaining 3 patients. After surgery patients had marked pain relief, with an improved range of motion and grasping strength. Anatomic restoration of carpal angles and scaphoid length was observed. None of the patients required additional surgery. Before surgery 15 patients presented radiographic signs of wrist arthrosis. During surgery, however, cartilage erosion on the proximal pole or on the radius articular surface was not confirmed. Despite the presence of radiographic arthrosis, wrist symptoms, motion, and grasping strength improved after surgery.
  
  
  CONCLUSIONS
  Long-standing scaphoid nonunion, even in the presence of limited arthrosis, can be treated with surgery and healing promoted by a vascularized bone graft. Because of its versatility for use by dorsal or palmar approach and reliability, the first dorsal metacarpal artery vascularized bone graft represents our method of choice.
authors.affiliation: Hospital Governador Celso Ramos, Department of Orthopedics, Hand Surgery Unit, Florianópolis, SC, Brazil.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.forename: Cristiano Paulo
authors.initials: CP
authors.lastname: Tacca
authors.forename: Jan Richard
authors.initials: JR
authors.lastname: Rost
mesh_terms: D000328:Adult; D001158:Arteries / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008663:Metacarpus / Q000637:transplantation; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013933:Thumb / Q000098:blood supply; D020858:Tissue and Organ Harvesting / Q000379:methods; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*