Primary Vascularized Bone Graft for the Extruded Scaphoid Proximal Pole

A vascularized bone graft from the dorsoradial aspect of the distal radius was used with internal fixation to treat nonunion of the scaphoid in ten patients who had not received any previous surgical treatment. Five cases were classified as Lichtman type I and five as type II. The average age was 30 years (range, 18–40 years). Associated avascular necrosis was observed in five cases. Post-operatively pain was relieved and union was achieved in all cases. The mean time to union was 6.5 weeks. Range of motion, grip strength and pinch strength were also restored satisfactorily. These results suggest that this vascularized bone graft should be used as the primary procedure in Lichtman type I and II of scaphoid nonunions, regardless of the presence of avascular necrosis of the proximal pole.

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Scaphoid Nonunion: Treatment with a Pedicled Vascularized Bone Graft Based on the 1,2 Intercompartmental Supraretinacular Branch of the Radial Artery

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0808 ◽

2002 ◽

Vol 27 (5) ◽

pp. 413-416 ◽

Cited By ~ 118

Author(s):

R. G. STRAW ◽

T. R. C. DAVIS ◽

J. J. DIAS

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Scaphoid Fracture ◽

Vascularized Bone Graft ◽

Scaphoid Nonunion ◽

Proximal Pole ◽

Union Rate ◽

Fracture Nonunions ◽

Vascularized Bone

Pedicled vascularized bone grafts (Zaidemberg’s technique) were used to treat 22 established scaphoid fracture nonunions, 16 of which were found to have avascular proximal poles at surgery. After a follow-up of 1–3 years, only six (27%) of the 22 fracture nonunions had united. Only two of the 16 nonunions with avascular proximal poles united, compared with four of the six nonunions with vascular proximal poles. We conclude that this technique of pedicled vascularized bone grafting may not improve the union rate for scaphoid fracture nonunions with avascular proximal pole fragments.

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Pronator quadratus pedicled bone graft for scaphoid non-unions

International Surgery Journal ◽

10.18203/2349-2902.isj20203960 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3414

Author(s):

Harsha Vardhan ◽

Anto Francis

Keyword(s):

Bone Graft ◽

Fracture Healing ◽

Scaphoid Fracture ◽

Fracture Site ◽

Vascularized Bone Graft ◽

Proximal Pole ◽

Pronator Quadratus ◽

Scaphoid Fractures ◽

Fracture Nonunion ◽

Vascularized Bone

Scaphoid fractures frequently present with nonunion and proximal pole necrosis, the treatment of which is bone grafting. Pronator quadratus pedicled vascularized bone graft is an option especially in the setting of proximal pole necrosis. We describe our experience of managing such scaphoid non-unions using pronator quadratus pedicled vascularized bone graft. Six patients were managed using pronator quadratus pedicled vascularized bone graft following scaphoid fracture nonunion with proximal pole necrosis. All patients had good fracture healing and symptom resolution. Mild deficit in wrist extension was noted in all patients. Pronator quadratus pedicled vascularized bone graft is an attractive option for managing scaphoid nonunion. Lying adjacent to the fracture site, bone can be harvested and transferred without making any other incisions. This procedure introduces another source of blood supply to the fracture site and hence improves fracture healing.

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