Treatment of scaphoid non-unions by a palmar approach with vascularised bone graft harvested from the thumb

• Published in: Journal of hand surgery, British volume British volume, 2007-04, Vol.32 (2), p.217-223
• Main Authors: Bertelli, J.A., Peruchi, F.M., Rost, J.R., Tacca, C.P.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bone Transplantation - methods; Cohort Studies; Fracture Healing; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Hand Strength; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Metacarpal Bones - blood supply; Metacarpal Bones - transplantation; Middle Aged; Orthopedic surgery; Pain Measurement; Radiography; Range of Motion, Articular; Scaphoid Bone - diagnostic imaging; Scaphoid Bone - injuries; Scaphoid Bone - surgery; scaphoid fracture; scaphoid non-union; scaphoid pseudoarthrosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thumb - blood supply; Thumb - surgery; thumb metacarpal; Traumas. Diseases due to physical agents; vascularised bone grafts; wrist instabilities
• ISSN: 0266-7681; 1753-1934; 1532-2211; 2043-6289
• DOI: 10.1016/j.jhsb.2006.10.014

Ten patients with scaphoid non-unions which had been present for longer than 2 years were treated using a vascularised bone graft harvested from the thumb and pedicled on the first dorsal metacarpal artery. Bone harvesting and grafting were performed by a single palmar approach. Concomitant cancellous bone graft was not used. Bone healing was confirmed by CT scans in nine of the ten patients. Persistence of the non-union was observed in one patient who was the oldest in this series, had the longest standing non-union and was a heavy smoker. Twelve months after surgery, nine of the ten patients had significant pain relief with an improved range of motion and grip strength.