Mike Hayton treats many patients with scaphoid fractures. If the scaphoid fracture does not heal there are a number of techniques that may be used to attempt to unite (heal) the scaphoid bone. We have reported our recent results in the use of a vascularised periosteal patch for scaphoid non unions. This is the abstract as it appears in Pub Med. The Original article is in the Journal of Bone and Joint Surgery. The results are disappointing, and since this research has been completed we no longer perform this surgery.
J Bone Joint Surg Br. 2008 Dec;90(12):1597-601. Links
The use of a vascularised periosteal patch onlay graft in the management of nonunion of the proximal scaphoid.
Thompson NW, Kapoor A, Thomas J, Hayton MJ.
Wrightington Hospital, Wigan, England.
We describe the use of a vascularised periosteal patch onlay graft based on the 1,2 intercompartmental supraretinacular artery in the management of 11 patients (ten men, one woman) with chronic nonunion involving the proximal third of the scaphoid. The mean age of the patients was 31 years (21 to 45) with the dominant hand affected in eight. Six of the patients were smokers and three had undergone previous surgery to the scaphoid. All of the proximal fragments were avascular. The presence of union was assessed using longitudinal axis CT. Only three patients progressed to union of the scaphoid and four required a salvage operation for a symptomatic nonunion. The remaining four patients with a persistent nonunion are asymptomatic with low pain scores, good grip strength and a functional range of wrist movement. Although this technique has potential technical advantages over vascularised pedicled bone grafting, the rate of union has been disappointing and we do not recommend it as a method of treatment.