title: [Scaphoid pseudarthrosis : Indications for avascular iliac crest or radius bone grafts].
abstract: BACKGROUND
  Operative treatment of the scaphoid nonunion includes avascular corticocancellous and cancellous bone grafts and increasingly the use of vascular pedicled and free vascular corticocancellous grafts. Especially the latter require a fair amount of operative expertise and experience in microsurgical techniques.
  
  
  OBJECTIVE
  Which criteria lead to the decision for or against an avascular graft used for reconstruction of scaphoid nonunion? Is our current classification system of a scaphoid pseudarthrosis able to illustrate our diagnostic potential in a way that makes us refer to operative procedures?
  
  
  METHODS
  Evaluation of current literature and expert opinions RESULTS: Avascular bone grafts show a high union rate as long as a sufficient vascularisation of the remaining fragments is present. In general, patients benefit from a very good functional outcome. Even revisions of failed scaphoid union may be successfully treated with an avascular bone graft. Failures of union are repeatedly experienced in treating proximal pole fractures with critical vascularisation or extensive bone loss, especially including avascular necrosis of the proximal pole (AVN). Current classification systems do not allow description and correlation of morphologic findings so as to compare results profoundly and to recommend specific procedures.
  
  
  CONCLUSIONS
  As long as sufficient vascularisation of remaining fragments is seen, the avascular bone graft is eligible for reconstructing scaphoid nonunion. Classification systems do not seem to reflect the status quo of diagnostic possibilities and make it difficult to provide guidelines for state-of-the-art operative procedures.
authors.affiliation: Abt. Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland. ariane.asmus@ukb.de.
authors.forename: A
authors.initials: A
authors.lastname: Asmus
authors.affiliation: Handchirurgie, obere Extremität und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Krankenhaus Waldfriede e.V., Argentinische Allee 40, 14163, Berlin, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Lautenbach
authors.affiliation: Abt. Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Schacher
authors.affiliation: Abt. Hand- und funktionelle Mikrochirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruchstr, 17475, Greifswald, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.affiliation: Abt. Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland.|Abt. Hand- und funktionelle Mikrochirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruchstr, 17475, Greifswald, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Eisenschenk
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D000066491:Clinical Decision-Making / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D018579:Patient Selection; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011884:Radius / Q000637:transplantation*; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome
keywords: Avascular necrosis of bone; Fractures of carpal bones; Grafting, bone; Os scaphoideum; Pseudarthrosis