Scaphoid non union

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  34 year old male suffers a fall and fractures his wrist ,X ray reveals that he has undisplaced scaphoid bone fracture . A  cast was applied , but fracture refused to heal and went into nonunion. So that gentlemen was referred to us .  
X ray showing non union Scahoid

vascularised bone graft in bone gap with head less screw in place
A P view

Lateral view


Artery marked in blue and bone graft being elevated


bone graft with pedicle fully elevated

dissection of  Scaphoid bone non union site



Scaphoid non union is troublesome condition it results in pain and weakness. Though some patients live well with it but majority seek treatment . I usually do vascularized bone grafting in Scaphoid non union . We usually take outer table of radius based on 1,2 intercompartmental supraretinacular branch of radial artery it gives adequate chunk of bone ,just good enough to fit inside non union site. Scaphoid is dissected and non union site is freshened and then bone graft is elevated , and fixed at non union site with a head less screw. And post op cast is applied for 4 weeks , after 4 weeks cast is removed and gently mobilization is done.
Union rate is excess of 95%, failure is rare, We dissect and harvest bone graft in tourniquet but releaseit to check bleeding and vascularity of bone graft.

Scaphoid bone has anatomical issue that blood supply to proximal pole comes through  distal part of bone through retrograde manner , If the fracture goes between distal part and proximal pole then the risk of non union remain . Not all fractures goes for non union but for select it becomes misery. Vascularized bone grafting bring fresh blood supply to the fracture site and promotes neovascularization in proximal pole and results in healing of fracture.


Dr Adhishwar Sharma +91 8860650846   adhishwar7@gmail.com

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