title: Vascularized bone grafts from the palmar radius for the treatment of waist nonunions of the scaphoid.
abstract: OBJECTIVE
  With their intrinsic vascularity vascularized bone grafts provide an alternative solution to the challenging problem of scaphoid nonunions. The union rate (after imaging evaluation including magnetic resonance imaging [MRI]) and functional outcome of using vascularized bone grafts pedicled on the palmar carpal epiphyseal artery for waist nonunions of the scaphoid are reported in this prospective case series.
  
  
  METHODS
  The technique was applied to 9 waist nonunions resulting from fractures. The mean time elapsed from the initial injury to the procedure was 22 months and the mean follow-up time was 24 months. The graft was pedicled on the artery running at the distal edge of the pronator quadratus and was inserted in the nonunion as an intercalary graft. Six patients had postoperative MRIs to evaluate fracture healing and graft incorporation.
  
  
  RESULTS
  Union was accomplished in all cases between 6 and 12 weeks. Postoperative MRI showed the viability of the graft (contrast-enhanced images) and confirmed union and graft incorporation. Complete absence of pain was noted in all patients. The Mayo modified wrist score increased from 63 to 92 after surgery and according to this score results were excellent in 5 patients and good in 4.
  
  
  CONCLUSIONS
  Vascularized bone grafts from the anterior radius lead to rapid union and consolidation in cases of waist nonunion. Postoperative MRI confirms viability of the graft, union, and graft incorporation. The approach is limited to the distal radius and wrist and lacks donor site morbidity. The interposition of the graft from the palmar side allows correction of the humpback deformity and patients regain carpal height, grip strength, and painless motion.
  
  
  METHODS
  Therapeutic, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Zoe H
authors.initials: ZH
authors.lastname: Dailiana
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
authors.forename: Vasileios
authors.initials: V
authors.lastname: Zachos
authors.forename: Sokratis E
authors.initials: SE
authors.lastname: Varitimidis
authors.forename: Michael
authors.initials: M
authors.lastname: Hantes
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karantanas
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D005500:Follow-Up Studies; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D011884:Radius / Q000098:blood supply* / Q000637:transplantation*; D016059:Range of Motion, Articular / Q000502:physiology; D021361:Scaphoid Bone / Q000293:injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery