• Oper Orthop Traumatol · Nov 2009

    Clinical Trial

    [Pedicled vascularized bone grafts from the dorsum of the distal radius for treatment of scaphoid nonunions].

    • Michael Sauerbier, Allen T Bishop, and Nina Ofer.
    • Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Germany. msauerbier@kliniken-mtk.de
    • Oper Orthop Traumatol. 2009 Nov 1; 21 (4-5): 373-85.

    ObjectiveBony healing and reconstruction of the scaphoid with use of a reverse-flow pedicle vascularized bone graft from the dorsal aspect of the distal radius. Revitalization of the proximal fragment in case of avascular necrosis.IndicationsScaphoid nonunion, especially of the proximal pole. Nonunion after failed attempts of autogenous nonvascularized bone grafting. Avascular necrosis of the scaphoid (Preiser's disease). Avascular osteonecrosis of other carpal bones (i.e., Kienböck's disease stage II and IIIa). However, these will not be addressed in this paper.ContraindicationsAdvance carpal collapse (SNAC [scaphoid nonunion advanced collapse] wrist stage II and III). Avascular necrosis with broken proximal pole of the scaphoid. Malformation, disease or previous injury of the vascular system.Surgical TechniqueReconstruction of the scaphoid by interposition of a vascularized bone graft from the dorsum of the distal radius, where several vascularized bone grafts can be harvested, and fixation by a scaphoid screw.Postoperative ManagementManagement Immobilization for 6 weeks in a forearm cast including the first phalanx of the thumb.Results48 scaphoid nonunions were treated with 1,2-ICSRA-based (intercompartmental supraretinacular artery) vascularized bone grafts: 34 scaphoid nonunions went on to union at an average of 15.6 weeks after surgery.

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