The use of pedicled vascularized bone grafts in the treatment of scaphoid nonunion: clinical results, graft options and indications

Abstract

Scaphoid nonunion is a challenging situation for orthopaedic surgeons. Nonunion rate is especially high in proximal pole fractures of the scaphoid due to tenuous retrograde blood supply. The use of pedicled vascularized bone grafts for the treatment of scaphoid nonunion provides both good clinical and radiological outcomes. The preserved vascularity of the graft leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the conventional non-vascularized grafting. Pedicled vascularized bone grafts also allow the correction of the carpal alignment and humpback deformity of the scaphoid. Clinical and radiological results have been satisfactory and promising, making us anticipate that the role of vascularized bone grafting for the treatment of carpal diseases will increase. Cite this article: EFORT Open Rev 2020;5:1-8. DOI: 10.1302/2058-5241.5.190021