Longstanding nonunions of scaphoid fractures with bone loss: successful reconstruction with vascularized bone grafts

Vascularized bone graft from the dorsum of distal radius was used to treat 22 nonunions of scaphoid fractures, with a mean delay of 4 years from the initial injury. Four of the eight patients with associated scapho-styloid arthritis also underwent a closing wedge osteotomy of the distal radius. Follow-up time ranged from 14 to 74 months. Union was accomplished in 6 to 12 weeks and wrist range of motion and grip strength improved postoperatively in all patients. Complete absence of pain was noted in 16 patients and the other six, all of whom had arthritic wrist changes or carpal collapse, only experienced pain with strenuous activities. The simple graft dissection, the avoidance of anastomoses and the lack of donor site morbidity are additional advantages to this surgical technique, which is successful even in cases with an avascular proximal pole.