PMID: 16520615Mar 8, 2006Paper

Vascularized bone grafting and herbert screw fixation of scaphoid nonunions with avascular proximal poles

Techniques in Hand & Upper Extremity Surgery
Arshad R Muzaffar, P R Carter

Abstract

Nonunion of the fractured scaphoid can present a difficult surgical problem, especially in fractures near the proximal pole. The incidence of nonunion is greater in this region, in which the vascularity of the proximal fracture segment is compromised and the proximal fragment is small and resists rigid fixation. Recent development of better vascularized bone grafting techniques has provided a tool with which to address this vexing problem. Because many authors had previously shown the advantage of rigid fixation in obtaining scaphoid union, it seemed advantageous to us to combine these two methods-rigid fixation and improved vascularity. In this article, we present in detail our technique for treating patients with very small proximal pole fractures in which the proximal fragment makes up less than 20% of the scaphoid. For practical purposes, all of these fractures have a proximal fragment that is avascular. We use a vascularized bone graft as described by Zaidemberg et al. in combination with more rigid fixation of proximal pole fractures using the Herbert mini screw. Although the technique presented requires the surgeon to use precise surgical technique, early results have been encouraging, and patients with very small fractu...Continue Reading

References

Dec 1, 1992·The Journal of Hand Surgery : Journal of the British Society for Surgery of the Hand·G Lindström, A Nyström
May 1, 1991·The Journal of Hand Surgery·C ZaidembergC Angrigiani
Sep 1, 1988·The Journal of Hand Surgery·W P CooneyM B Wood
Nov 1, 1988·The Journal of Bone and Joint Surgery. British Volume·H Kawai, K Yamamoto
Jun 1, 1987·The Journal of Hand Surgery : Journal of the British Society for Surgery of the Hand·J N KuhlmannS Baux
Jan 1, 1987·The Journal of Bone and Joint Surgery. British Volume·D J FordF D Burke
Jan 1, 1984·International Orthopaedics·P B Chacha
Feb 11, 1999·The Journal of Bone and Joint Surgery. American Volume·B M RajagopalanL O Samuels

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