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 i nitial injury. Four of the eight patients with associated scapho-styloid ar thritis also underwent a closing wedge osteotomy of the distal radius. Foll ow-up time ranged from 14 to 74 months. Union was accomplished in 6 to 12 w eeks and wrist range of motion and grip strength improved postoperatively i n all patients. Complete absence of pain was noted in 16 patients and the o ther six, all of whom had arthritic wrist changes or carpal collapse, only experienced pain with strenuous activities. The simple graft dissection, th e avoidance of anastomoses and the lack of donor site morbidity are additio nal advantages to this surgical technique, which is successful even in case s with an avascular proximal pole.