title: Non-vascularized bone grafting in scaphoid nonunion: principles and type of fixation.
abstract: In scaphoid fractures, delayed diagnosis and nonunion are fairly common as a result of several factors, including the difficulty of radiographic diagnosis of non-displaced fractures and underestimation of the injury by the patient. Main factors to consider when deciding treatment are the type of fracture and fracture stability. In the stable nonunion (Type D1 according to the Filan and Herbert classification, or linear type of Ikeda's classification), percutaneous screw fixation without bone graft is recommended. The indications of non-vascularized bone grafting are as follows: (1) arthroscopic cancellous bone graft in type D1 and cystic type of Ikeda's classification. (2) tricortical bone graft from the iliac crest in type D2 or D3 if the possibility of avascular necrosis of the proximal fragment is excluded. In this paper, our non-vascularized bone grafting for scaphoid nonunion would like to be described mainly about principles and type of fixation.
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Uesato
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. tohs327@yahoo.co.jp.|Department of Orthopaedic Surgery, Hirosaki National Hospital, National Hospital Organization, Hirosaki, Japan. tohs327@yahoo.co.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toh
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Maniwa
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ishibashi
mesh_terms: D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008488:Medical Illustration; D010020:Osteonecrosis / Q000503:physiopathology / Q000601:surgery; D010347:Patient Care Planning; D011182:Postoperative Care; D011300:Preoperative Care; D019736:Prostheses and Implants; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome
keywords: Arthroscopic bone graft; Non-vascularized bone graft; Scaphoid nonunion