Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting. J Bone Joint Surg Am

ABSTRACT: Eleven patients who had an ununited fracture of the scaphoid associated with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay cortico-cancellous bone graft from the iliac crest and implan-tation of the second dorsal intermetacarpal artery, its accompanying venae comitantes, and a thin cuff of perivascular tissue. The absence of the blood supply to the proximal pole was evidenced both by radiographic changes- which included increased bone density, absence of normal trabeculae, and cystic changes-and by failure to observe bleeding bone during the operation. There were ten men and one woman. The average duration of non-union was fourteen months (range, si