NONUNION OF THE SCAPHOID - REVASCULARIZATION OF THE PROXIMAL POLE WITH IMPLANTATION OF A VASCULAR BUNDLE AND BONE-GRAFTING

Eleven patients who had an ununited fracture of the scaphoid associate d with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay corticocancellous bone graf t from the iliac crest and implantation of the second dorsal intermeta carpal artery its accompanying venae comitantes, and a thin cuff of pe rivascular tissue. The absence of the blood supply to the proximal pol e was evidenced both by radiographic changes - which included increase d bone density, absence of normal trabeculae, and cystic changes - and by failure to observe bleeding bone during the operation. There were ten men and one woman, The average duration of non-union was fourteen months (range, six to thirty-three months), Six patients had had previ ous unsuccessful operative attempts to obtain union. Eight non-unions were in the proximal one-third and three, at the waist of the scaphoid , Union was achieved in ten patients at an average of ten weeks postop eratively. According to the wrist-scoring system of the Mayo Clinic, a t an average of five years (range, 2.5 to eleven years), three patient s had a grade of excellent; three, good; three, fair; and two, poor, F our patients had subsequent reconstructive procedures: radial styloide ctomy, styloidectomy and resection of osteophytes, radioscapholunate a rthrodesis, and total wrist arthrodesis were performed in one patient each.