Scaphoid Nonunion treated with vascularized bone graft

We reviewed 26 cases of scaphoid nonunion treated with a vascularized pedicle bone graft. The average duration from the time of injury to the time of operation was 54.6 months (in 10 cases, it was more than 5 years). Of the 26 cases, 22 were treated with a vascularized bone graft from the distal end of the radius (Zaidemberg method) and 4, with one from the base of the second metacarpal (Makino method). The scaphoid was fixed using a Herbert screw in 9 cases and a K-wire in 15 cases. In 2 cases, the original Herbert screw was not removed from the scaphoid during revision surgery for scaphoid nonunion. Bone union was achieved in all cases. The results obtained were scored according to the Cooney clinical scoring chart; 9 cases were rated as excellent; 14, as good; and 3, as fair. Based on the results, it appears that the surgeon should select the best procedure to adopt for treating scaphoid nonunion with consideration to the patient's age, the site of nonunion, MRI findings, and bony condition. (author)