Abstract
Background Scaphoid non-union remains a difficult problem to treat effectively. Screw fixation and standard bone grafting techniques are good options with union reported in approximately 90% of cases. Studies of the vascular supply to the distal radius have revealed a consistent vascular bone graft source from the dorsal radius. This allows for a pedicled vascularised bone graft to be fashioned, further enhancing the local blood supply to the fracture site.
Methods 14 male patients with a mean age of 30 years (21 to 51 years) and a mean duration of injury of 57 months (15 – 348 months) underwent vascularised bone grafting of established non–union of the scaphoid. The graft was vascularised with a pedicle based on the 1, 2 intercompartmental supraretinacular branch of the radial artery. In addition the long standing deformity resulting from the non-union was corrected by a tri-cortical iliac crest bone graft. (The results were assessed with regard to evidence of union at the fracture site and resolution of pain with return of function). Some of the cases had previous operations with conventional bone graft and failed.
Results Fracture healing was demonstrated radiologically in 9 of 14 cases (64%). 12 of 14 cases (86 %) showed resolution of pain and improvement in function.
Conclusion This technique shows promising results for treating established non-union of the scaphoid, even after long intervals between initial injury and the grafting procedure.
Correspondence should be addressed to Major S A Adams, Orthopaedic Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA.
