REPEAT RUSSE BONE-GRAFTING AFTER FAILED BONE-GRAFT SURGERY FOR SCAPHOID NONUNION

We report the long-term outcome of repeat Russe bone grafting after fa ilure of a previous Russe graft for scaphoid non-union. 15 patients we re followed for a mean of 71 months after their last surgical procedur e. 11 patients had undergone a single previous Russe graft and four pa tients had two previous graft attempts. Internal fixation was used in only three patients. Eight out of 15 (53%) patients achieved union aft er a single repeat graft and one out of four united after a third atte mpt. When union was achieved, range of motion was unchanged, grip stre ngth was increased 10%, and pain was slight to none, allowing return t o full employment in seven out of the nine patients. Ah patients who d id not achieve union have either undergone a salvage procedure or are contemplating one. Based on the literature and our relatively low rate of union without internal fixation (53%), we recommend supplementary internal fixation if repeat Russe bone grafting is undertaken, When un ion is achieved, satisfactory results can be expected.