Use of the 1,2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion

Fourteen patients with established scaphoid nonunion were treated with vascularized pedicle bone grafting. All nonunions healed at a mean of 11.1 weeks (range, 8-16 weeks). Wrist motion was minimally affected by surgery. Intercarpal and scaphoid angles were improved after surgery, particularly in patients with preoperative humpback deformity who had previous interposition grafting. Outcome, based on a self-assessment questionnaire administered at a mean 30 months of follow-up (range, 19-53 months), showed 2 excellent, 7 good, 4 fair, and 1 poor result. Three patients showed progressive radioscaphoid arthrosis. Vascularized bone grafts are indicated in proximal pole fracture nonunions, in the presence of avascular necrosis, and after conventional grafts. Radiocarpal arthritis, if present before surgery, is a poor prognostic sign.