Scaphoid Non-Union: The Role of Vascularized Grafting In Recalcitrant Non-Unions of the Scaphoid

Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-u...

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Bibliographic Details
Published in:Journal of hand surgery, British volume British volume, 2006-04, Vol.31 (2), p.185-190
Main Authors: TAMBE, A. D., CUTLER, L., STILWELL, J., MURALI, S. R., TRAIL, I. A., STANLEY, J. K.
Format: Article
Language:English
Subjects:
Adult
Bone Screws
Bone Transplantation - methods
Bone Wires
Female
Fracture Fixation, Internal - methods
Fractures, Ununited - surgery
Humans
Male
Middle Aged
Osteotomy
Pseudarthrosis - etiology
Pseudarthrosis - surgery
Radius - blood supply
Radius - transplantation
Retrospective Studies
Scaphoid Bone - blood supply
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Summary:Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-union were treated with vascularized pedicle bone grafting and supplementary corticocancellous grafting. Five had screw fixation and six were fixed with K-wires. The average age of the patients was 28 years, average duration of the non-union was 39 months and mean radiological follow-up was 32 months. There were no significant skeletal complications, although two patients developed neuromata. At review, only six of the 11 non-unions were united. Whilst this is a difficult clinical problem and achieving union is a formidable challenge, we believe that there is a role for such extensive surgery in order to achieve good postoperative function.
ISSN:0266-7681
1532-2211
DOI:10.1016/J.JHSB.2005.09.012