Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: A retrospective study in 60 cases

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to a chieve bone union and to restore the scaphoid. Many procedures are describe d to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that las ted longer than 4 years, 26 with an avascular pole fragment, and 13 with sc aphoid nonunion after previous surgery) who were treated by a small free va scularized iliac crest bone graft. All 60 patients have routinely been Foll owed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 p ercent, leading to progressive arthritis and carpal collapse. Complaints co ncerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony de formity. Bone deformations on the donor site were detected radiologically i n 63.3 percent of the patients. In 31.7 percent, an impairment of the later al femoral cutaneous nerve was noted. Reconstruction of the scaphoid by mea ns of implantation of a vascularized iliac bone graft proved efficient to t reat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avasc ular proximal pole fragments.