title: Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion.
abstract: BACKGROUND
  Since proximal pole fractures of the scaphoid are frequently overlooked, the poor vascularity in the proximal pole fragment often leads to nonunion. Vascularized bone grafts have been recently tested in cases with scaphoid proximal pole nonunion, but the indication for this treatment has not been well established. Alternatively, we have been treating such patients with a non-vascularized iliac bone graft and Herbert-type screw fixation with considerable success. The purpose of this investigation is to evaluate these cases retrospectively and clarify the surgical efficacy of our procedure.
  
  
  METHODS
  Between 1996 and 2009, 11 consecutive patients with proximal pole scaphoid nonunion were treated with a non-vascularized corticocancellous iliac bone graft and Herbert-type screw fixation. They were all male aged from 12 to 26 years. In two patients, avascular changes were recognized in the proximal pole in preoperative radiographs or MRI. Follow-up ranged from 12 to 76 months.
  
  
  RESULTS
  Bone union was radiographically confirmed in all patients, who returned to their former activities without any complications. The period from operation to union ranged from 12 to 24 weeks. The mean Mayo modified wrist score was 76.4 points preoperatively and 91.4 points postoperatively, and was improved in all cases.
  
  
  CONCLUSIONS
  A non-vascularized iliac bone graft with Herbert-type screw fixation obtained satisfactory clinical and radiographic results in cases with scaphoid proximal pole nonunion, regardless of the vascularity in the proximal fragment.
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. matsuki_h@marunouchi.or.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsuki
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishikawa
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult