title: Volar plate fixation of recalcitrant scaphoid nonunions with volar carpal artery vascularized bone graft.
abstract: Chronic scaphoid fracture nonunion continues to present a significant challenge to the treating orthopedic surgeon. Internal fixation with threaded compression screws leads to high union rates, and is currently the gold standard, but there are certainly circumstances where a scaphoid screw does not provide the stability necessary for nonunion repair. Results using a volar buttress plate have been promising, but have not been described in conjunction with the use of vascularized bone graft. Vascularized bone grafts have been shown to be highly effective in achieving rapid and reproducible rates of union. We describe a novel combination of a vascularized volar distal radius wedge autograft pedicled on the volar carpal artery and volar buttress plating for salvage treatment of chronic scaphoid nonunion.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Dodds
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Patterson
authors.forename: Andrea
authors.initials: A
authors.lastname: Halim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D000075202:Contraindications; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care; D011884:Radius / Q000098:blood supply* / Q000637:transplantation*; D016059:Range of Motion, Articular; D016879:Salvage Therapy; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery*; D013165:Splints; D055815:Young Adult