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The Journal of Bone and Joint Surgery, Vol 77, Issue 6 883-893, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting
DL Fernandez and S Eggli
Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland.
Eleven patients who had an ununited fracture of the scaphoid associated
with loss of the blood supply to the proximal fragment were managed
operatively with a combination of an inlay corticocancellous bone graft
from the iliac crest and implantation of the second dorsal intermetacarpal
artery, its accompanying venae comitantes, and a thin cuff of perivascular
tissue. The absence of the blood supply to the proximal pole was evidenced
both by radiographic changes--which included increased bone density,
absence of normal trabeculae, and cystic changes--and by failure to observe
bleeding bone during the operation. There were ten men and one woman. The
average duration of non-union was fourteen months (range, six to
thirty-three months). Six patients had had previous unsuccessful operative
attempts to obtain union. Eight non-unions were in the proximal one-third
and three, at the waist of the scaphoid. Union was achieved in ten patients
at an average of ten weeks postoperatively. According to the wrist-scoring
system of the Mayo Clinic, at an average of five years (range, 2.5 to
eleven years), three patients had a grade of excellent; three, good; three,
fair; and two, poor. Four patients had subsequent reconstructive
procedures; radial styloidectomy, styloidectomy and resection of
osteophytes, radioscapholunate arthrodesis, and total wrist arthrodesis
were performed in one patient each.
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