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Vascularized Bone Graft for Scaphoid Nonunions

Mih, Alexander D MD

Techniques in Hand & Upper Extremity Surgery: September 2004 - Volume 8 - Issue 3 - p 156-160
doi: 10.1097/01.bth.0000128544.55943.92

Scaphoid fracture nonunion remains a challenging problem that may persist despite traditional methods of bone grafting and internal fixation. The alteration of wrist mechanics created by nonunion as well as the development of avascular necrosis leads to degenerative change of the radiocarpal joint accompanied by loss of motion and pain. The use of a vascularized bone graft has the theoretical benefit of increased blood flow that exceeds that of nonvascularized grafts. Numerous sources of vascularized bone graft have been described, including those from remote sites as well as from the carpus and distal radius. Knowledge of the blood supply to the distal radius has allowed for development of several vascularized bone graft harvest sites. The results of vascularized bone grafting from the distal radius have been encouraging, with numerous authors reporting the successful treatment of scaphoid nonunions.

Department of Orthopaedic Surgery

Indiana University School of Medicine

Indiana Hand Center

Indianapolis, IN

Address correspondence and reprint requests to Alexander D. Mih, MD, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indiana Hand Center, 541 Clinical Drive, Room 600, Indianapolis, IN 46202. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.