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PubMed1987

[Alternative surgical method in pseudarthroses of the scaphoid bone. Prospective study].

Follow-up of 197 patients with scaphoid nonunion treated by Russe I and Russe II bone grafting procedures showed that in longstanding cases with pseudarthrosis and in cases with severe necrosis bony union is often not achieved. The reason for this lack of success is the bad vascularity of the damaged scaphoid. In these cases (25 cases performed over 19 months) with an unfavorable operative prognosis we have inserted into the scaphoid after resection of the pseudarthrosis or the necrotic bone, a corticocancellous graft from the iliac crest, isolated on its vascular pedicle. The vascular pedicle has been anastomosed under the microscope to the radial artery and one of the accompanying veins. This procedure guarantees a much better vascularity of the bone graft. Our results in the 25 cases are very encouraging. Possible complications and their avoidance are pointed out. This new operative technique should not replace other common procedures but it might be the treatment of choice in selected cases.

Adult↗
PubMed1980

The vascularity of the scaphoid bone.

The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. The major blood supply to the scaphoid is via the radial artery. Seventy to eight percent of the intraosseous vascularity and the entire proximal pole is from branches of the radial artery entering through the dorsal ridge. Twenty to thirty percent of the bone, in the region of the distal tuberosity, receives its blood supply from volar radial artery branches. There is an excellent collateral circulation to the scaphoid by way of the dorsal and volar branches of the anterior interosseous artery. An explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy is proposed. The volar operative approach would be least traumatic to the proximal pole's blood supply.

Arm↗