Free Medial Femoral Condyle Vascularized Bone Grafting for Scaphoid Nonunions with Proximal Pole Avascular Necrosis and Carpal Collapse

Treating scaphoid nonunions complicated by avascular necrosis and collapse with humpback deformity has proven challenging. Conventional nonvascularized interposition grafts restore the structural architecture, but fail to restore the vascular supply to the scaphoid. Pedicled inlay grafts restore blood flow, but fail to correct the humpback deformity or restore scaphoid length. Restoration of both vascularity and geometry is critical for promoting bony union. The free vascularized medial femoral condyle bone graft provides both and has proven successful in treating this problematic subset of scaphoid nonunions. The rationale, indications, contraindications, anatomical basis, and technique of scaphoid preparation, bone graft harvest, insetting, fixation, and microvascular anastomosis are presented for the treatment of scaphoid nonunions with avascular necrosis and carpal collapse.