Scaphoid non-union: the role of vascularized grafting in recalcitrant non-unions of the scaphoid.
Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-union were treated with vascularized pedicle bone grafting and supplementary corticocancellous grafting. Five had screw fixation and six were fixed with K-wires. The average age of the patients was 28 years, average duration of the non-union was 39 months and mean radiological follow-up was 32 months. There were no significant skeletal complications, although two patients developed neuromata. At review, only six of the 11 non-unions were united. Whilst this is a difficult clinical problem and achieving union is a formidable challenge, we believe that there is a role for such extensive surgery in order to achieve good postoperative function.
Tambe
A D
AD
Wrightington Hospital, Wrightington, Wigan & Leigh NHS Trust, UK. anant_tambe@yahoo.com
Cutler
L
L
Stilwell
J
J
Murali
S R
SR
Trail
I A
IA
Stanley
J K
JK
D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011542:Pseudarthrosis / Q000209:etiology / Q000601:surgery*; D011884:Radius / Q000098:blood supply* / Q000637:transplantation*; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000098:blood supply*