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Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting
DL Fernandez; S Eggli
J Bone Joint Surg Am, 1995 Jun 01;77(6):883-893
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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 corticocancellous bone graft from the iliac crest and implantation 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, six to thirty-three months). Six patients had had previous unsuccessful operative attempts to obtain union. Eight non-unions were in the proximal one-third and three, at the waist of the scaphoid. Union was achieved in ten patients at an average of ten weeks postoperatively. According to the wrist-scoring system of the Mayo Clinic, at an average of five years (range, 2.5 to eleven years), three patients had a grade of excellent; three, good; three, fair; and two, poor. Four patients had subsequent reconstructive procedures; radial styloidectomy, styloidectomy and resection of osteophytes, radioscapholunate arthrodesis, and total wrist arthrodesis were performed in one patient each.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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