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Combined Pedicled Vascularized and Wedge Nonvascularized Bone Graft for Treating Scaphoid Waist Nonunion With Humpback Deformity

Huang, Hui-Kuang MD*,†,‡,§; Wu, Chin-Hsien MD; Wang, Jung-Pan MD, PhD*,†; Tu, Yuan-Kun MD, PhD

Techniques in Hand & Upper Extremity Surgery: December 2019 - Volume 23 - Issue 4 - p 155–159
doi: 10.1097/BTH.0000000000000244

Pedicled vascularized bone graft (VBG) is a useful method in treating the scaphoid fracture nonunion, especially when the avascular necrosis exists. Humpback deformity is an important issue that we have to correct it during the treatment. We describe a method by using combined wedge non-VBG to correct the nonunion deformity when treating scaphoid nonunion with pedicled VBG. The wedge bone graft was harvested just proximal to the 2,3 intercompartmental supraretinacular artery VBG and was used as an inlay at the volar site to correct the humpback deformity, whereas the VBG was set at the dorsal site for bone bridging and blood supply. We also present our results of 10 patients with scaphoid fracture nonunion and humpback deformity treated with this method. Bone healing was achieved and the lateral intrascaphoid angles could be improved in all the 10 patients. Functional outcomes, including the Visual Analog Pain Scale for pain during activity, grip strength, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the modified Mayo Wrist Scores, were significantly improved.

*Department of Surgery, School of Medicine, National Yang-Ming University

Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei

Department of Orthopedics, Chiayi Christian Hospital, Chiayi

§Chung Hwa University of Medical Technology, Tainan

Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan

This study was approved by Institutional Review Board of Chiayi Christian Hospital (IRB number: 2018059).

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Yuan-Kun Tu, MD, PhD, Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, 824 Kaohsiung City, Taiwan. E-mail:

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