Dorsal distal radius vascularized pedicled bone grafts for scaphoid nonunions

Fractures of the scaphoid, particularly its proximal pole, are at risk of progressing to nonunion because of the tenuous, retrograde blood supply. The overall incidence of scaphoid fractures developing nonunion ranges from 10% to 15%, whereas proximal pole fractures of the scaphoid can have up to a 30% incidence of nonunion. Avascular necrosis of these proximal pole fractures can occur in 14% to 39% of cases. Dorsal distal radius vascularized pedicled bone grafting is an alternative to conventional measures for the treatment of displaced proximal pole fractures, established nonunions, and avascular necrosis of the proximal fragment. This graft is based on the 1,2-intercompartmental supraretinacular artery, which has reliable anatomy and predictable course between the first and second extensor compartments. The graft can be harvested and inset into the prepared fracture site using a single-incision approach. The indications, contraindications, technique, and results of treatment are reviewed and detailed.