Treatment of scaphoid nonunion with combined vascularized distal radius graft and iliac crest bone graft

The optimal treatment of scaphoid nonunion is a controversial and challenging task in hand surgery. Although advances in internal fixation techniques have resulted in improved union rates, fractures with impaired vascularity have less than satisfactory results with conventional grafting techniques. We describe the technique of using a tricortical iliac crest graft and a vascularized distal radius graft in cases of nonunion with avascular necrosis. The principle of our technique is to improve union rates over previously described procedures by addressing the issues of stability using a tricortical graft with compression through internal fixation and by improving biology using a cancellous vascularized graft.