Alternative vascularized grafts for longstanding scaphoid nonunions with bone loss

Vascularized bone grafts (VBG) have been used for the treatment of longstanding scaphoid nonunions with bone loss. From 53 patients treated with VBG, 29 consecutive patients were prospectively operated between 1999 and 2003 and followed for periods ranging from 7 months to 48 months. A dorsal VBG was used in 20 patients with nonunions of the proximal pole, and a palmar in 9 with waist nonunions. Union was accomplished in all cases in a time period of 6-12 weeks. All patients achieved almost complete resolution of pain in all activities. The findings of our series demonstrate the efficacy of the pedicled VBG from the adjacent radius to establish union and correct major alignment and angulation deformities in longstanding scaphoid nonunions. The choice of the most suitable VBG depends on the location of the nonunion.