Further experience with index metacarpal vascularised bone graft

We report our experience in the use of a vascularized bone graft harvested from the head of the index metacarpal to treat scaphoid nonunion after failure of other techniques. Only 15 patients were treated between 1988 and 1994, showing the scarcity of indications for the operation. Union was obtained in 14 cases but the functional results were acceptable in ten cases only. This was due to previously unnoticed egenerative l sions. Journal of Hand Surgery (British and European Volume, 1998) 23B. " 3. " 311-317 Treatment of scaphoid nonunion has always been diffi-cult. As it is often nearly asymptomatic, these pseudarthroses tend to be diagnosed late, when there may be necrosis of the proximal fragment with palmar flexion of the scaphoid on the radioscaphocapitate liga-ment and osteoarthritis. Moreover, vascularization of the scaphoid is often poor, complicated by a displaced fracture which prevents union. Surgical treatment of these pseudarthroses by interna