Skip to main content

Advertisement

SpringerLink
Log in

Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p = 0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barton NJ (1997) Experience with scaphoid grafting. J Hand Surg [Br] 22:153–160

    CAS  Google Scholar 

  2. Bilic R, Simic P, Jelic M, Stern-Padovan R, Dodig D, van Meerdervoort HP, Martinovic S, Ivankovic D, Pecina M, Vukicevic S (2006) Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 30(2):128–134

    Article  CAS  PubMed  Google Scholar 

  3. Boyer MI, Von Schroeder HP, Axelrod TS (1998) Scaphoid nonunion with avascular necrosis of the proximal pole. J Hand Surg [Br] 23:686–690

    CAS  Google Scholar 

  4. Cerezal L, Abascal F, Canga A, Garcia-Valtuille R, Pinal F (2000) Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. Am J Roentgenol 174:141–149

    CAS  Google Scholar 

  5. Chen ACY, Chao EK, Tu YK, Ueng SW (2006) Scaphoid nonunion treated with vascular bone grafts pedicled on the dorsal supra-retinacular artery of the distal radius. J Trauma 61:1192–1197

    Article  PubMed  Google Scholar 

  6. Cooney WP, Dobyns JH, Linscheid RL (1980) Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg [Am] 5:343–354

    Google Scholar 

  7. Dinah AF, Vickers RH (2007) Smoking increases failure rate of operation for established non-union of the scaphoid bone. Int Orthop 31(4):503–505

    Article  CAS  PubMed  Google Scholar 

  8. Filan SL, Herbert TJ (1996) Herbert screw fixation of fixation of scaphoid fractures. J Bone Joint Surg [Br] 78:519–529

    CAS  Google Scholar 

  9. Green DP (1985) The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg [Am] 10:597–605

    CAS  Google Scholar 

  10. Kuhlmann JN, Mimoun M, Boabighi A, Baux S (1987) Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid. J Hand Surg [Br] 12:203–210

    CAS  Google Scholar 

  11. Little CP, Burston BJ, Hopkinson-Woolley J, Burge P (2006) Failure of surgery for scaphoid non-union is associated with smoking. J Bone Joint Surg [Br] 31:252–255

    CAS  Google Scholar 

  12. Malizos KN, Dailiana ZH, Kirou M, Vragalas V, Xenakis TA, Soucacos PN (2001) Longstanding nonunions of scaphoid fractures with bone loss: successful reconstruction with vascularized bone grafts. J Hand Surg [Br] 26:330–334

    CAS  Google Scholar 

  13. Merrel GA, Wolfe S, Slade JF (2003) Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg [Am] 27:685–691

    Article  Google Scholar 

  14. Rath S, Leung PC (1990) Vascular anatomy of the pronator quadratus muscle-bone flap. A justification for its use with a distally based blood supply. J Hand Surg [Am] 15:630–636

    Article  CAS  Google Scholar 

  15. Robbins RR, Ridge O, Carter PR (1995) Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles. J Hand Surg [Am] 20:818–831

    Article  CAS  Google Scholar 

  16. Russe O (1960) Fracture of the carpal navicular. J Bone Joint Surg Am 42:759–768

    PubMed  Google Scholar 

  17. Schuind F, Haentijens P, Innis FV, Maren CV, Elias MG, Sennwald G (1999) Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg [Am] 24:761–776

    Article  CAS  Google Scholar 

  18. Sheetz KK, Bishop AT, Berger RA (1995) The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts. J Hand Surg [Am] 20:902–914

    Article  CAS  Google Scholar 

  19. Steinmann SP, Bishop AT, Berger RA (2002) Use of the 1,2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion. J Hand Surg [Am] 27:391–401

    Article  Google Scholar 

  20. Straw RG, Davis TRC, Dias JJ (2002) Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1, 2 inter-compartmental supraretinacular branch of the radial artery. J Hand Surg [Br] 27:413–416

    CAS  Google Scholar 

  21. Sunagawa T, Bishop AT, Muramatsu K (2000) Role of conventional and vascular bone grafts in scaphoid nonunion with avascular necrosis: a canine experimental study. J Hand Surg [Am] 25:849–859

    Article  CAS  Google Scholar 

  22. Waitayawinyu T, McCallister WV, Katolik LI, Schlenker JD, Trumble TE (2009) Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg [Am] 34:387–394

    Article  Google Scholar 

  23. Yuceturk A, Isiklar ZU, Tuncay C, Tandogan R (1997) Treatment of scaphoid nonunions with a vascularized bone graft based on the first dorsal metacarpal artery. J Hand Surg [Br] 22:425–427

    CAS  Google Scholar 

  24. Zaidemberg C, Siebert JW, Angrigiani C (1991) A new vascularized bone graft for scaphoid nonunion. J Hand Surg [Am] 16:474–478

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Nossa Senhora do Pari, São Paulo, Brazil

    Samuel Ribak, Carlos Eduardo Gonzalez Medina, Rames Mattar Jr., Heitor Jose Rizzardo Ulson, Marcelo Rosa de Resende & Mauricio Etchebehere

  2. Department of Orthopaedic Surgery, PUC Campinas University Hospital, Carapicuíba, Brazil

    Samuel Ribak, Carlos Eduardo Gonzalez Medina & Mauricio Etchebehere

  3. PUC Campinas University, Rua da Hortênsias 451, Carapicuíba, 06355-370, SP, Brazil

    Samuel Ribak

  4. Department of Orthopaedic Surgery, University of São Paulo, Faculty of Medicine, São Paulo, Brazil

    Rames Mattar Jr. & Marcelo Rosa de Resende

  5. Department of Orthopaedic Surgery, FCM UNICAMP, Campinas, Brazil

    Heitor Jose Rizzardo Ulson

Authors
  1. Samuel Ribak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Eduardo Gonzalez Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rames Mattar Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heitor Jose Rizzardo Ulson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcelo Rosa de Resende
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauricio Etchebehere
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel Ribak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ribak, S., Medina, C.E.G., Mattar, R. et al. Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius. International Orthopaedics (SICOT) 34, 683–688 (2010). https://doi.org/10.1007/s00264-009-0862-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-009-0862-6

Keywords

Search

Navigation