J Reconstr Microsurg 2003; 19(2): 099-106
DOI: 10.1055/s-2003-37814
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1 (212) 584-4662

Vascularized Second Metacarpal-Base Bone Graft in Scaphoid Non-Union by the Palmar Approach

Takuya Sawaizumi, Mitsuhiko Nanno, Hiromoto Ito
  • Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
Further Information

Publication History

Publication Date:
10 March 2003 (online)

ABSTRACT

Vascularized second metacarpal-base bone grafting from the palmar side for scaphoid non-union was performed in seven patients (six males and one female, with a mean age of 26 years). In all patients, bone union was obtained at a mean of 10.2 weeks. In six of the seven patients, preoperative dorsal intercalated segment instability (DISI) was corrected. The results were excellent in three patients, good in two patients, and fair in two patients, showing that more than 80 percent of the patients had satisfactory results. In this procedure, the second dorsal metacarpal artery, with a large vascular diameter, is used as the pedicle, and the second metacarpal base, which is abundant in cancellous bone, is elevated on the dorsal side and grafted on the open-wedged scaphoid non-union on the palmar side. This procedure is reliable and useful, particularly for scaphoid non-union with DISI.

REFERENCES

  • 1 Daly K, Gill P, Magnussen P A, Simonis R B. Established nonunion of the scaphoid treated by volar wedge grafting and Herbert screw.  J Bone Joint Surg . 1996;  78B 530-534
  • 2 Trumble T E, Clarke T, Kreder H J. Non-union of the scaphoid.  J Bone Joint Surg . 1966;  78A 1829-1837
  • 3 del Pinãl F. Treatment of nonunion of the scaphoid by a limited combined approach.  J Bone Joint Surg . 2001;  83B 78-82
  • 4 Kuhlman J N, Boabrighi A, Baux S. Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid.  J Hand Surg . 1987;  12B 203-210
  • 5 Guimberteau J C, Panconi B. Recalcitrant nonunion of the scaphoid treated with a vascularised bone graft based on the ulnar artery.  J Bone Joint Surg . 1990;  72A 88-97
  • 6 Zaidemberg C, Siebert J W, Angrigiani C. A new vascularized bone graft for scaphoid nonunion.  J Hand Surg . 1991;  16A 474-478
  • 7 Yuceturk A, Isiklar Z U, Tuncay C, Tandogan R. Treatment of scaphoid nonunion with a vascularized bone graft based on the first dorsal metacarpal artery.  J Hand Surg . 1997;  22B 425-427
  • 8 Yajima H, Ono H, Kizaki K, Yamauchi T, Tamai S. Vascularized bone graft for scaphoid necrosis and nonunion.  J Jpn Soc Surg Hand . 1998;  15 56-61
  • 9 Mathoulin C, Haerle M. Vascularised bone graft from the palmar carpal artery for treatment of scaphoid nonunion.  J Bone Joint Surg . 1998;  23B 318-323
  • 10 Mathoulin C, Brunelli F. Further experience with the index metacarpal vascularised bone graft.  J Hand Surg . 1998;  23 311-317
  • 11 Makino M. Vascularized metacarpal bone graft for scaphoid non-union and Kienböck's disease.  J Reconstr Microsurg . 2000;  16 261-267
  • 12 Filan S L, Herbert T J. Herbert screw fixation of scaphoid fractures.  J Bone Joint Surg . 1996;  78B 519-529
  • 13 Nakamura R, Horii E, Watanabe K, Miura T. Reduction of the scaphoid fracture with DISI alignment.  J Hand Surg . 1987;  12A 1000-1005
  • 14 Soejima O, Iida H, Komine S, Kituta T, Naito M. Lateral closing wedge osteotomy of the distal radius for advanced stage of Kienböck's disease.  J Hand Surg . 2002;  27A 31-36
  • 15 Cooney D P, Bussey R, Dobyns J H. Difficult wrist fractures: perilunate fracture-dislocation of the wrist.  Clin Orthop . 1987;  214 136-147
  • 16 Yousif N J, Ye Z, Sanger J R. et al . The versatile metacarpal and reverse metacarpal artery flaps in hand surgery.  Ann Plast Surg . 1992;  29 523-531
  • 17 Nakamura R, Horii E, Watanabe K, Tsunoda K, Miura T. Scaphoid non-union: factors affecting the functional outcome of open reduction and wedge grafting with Herbert screw fixation.  J Hand Surg . 1993;  18B 219-224
  • 18 Coony W P, Linscheid R L, Dobyns J H, Wood M B. Scaphoid nonunion: role of anterior interpositional bone grafts.  J Hand Surg . 1988;  13A 635-650
  • 19 Fernandez D L. Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions.  J Hand Surg . 1990;  5A 140-147
  • 20 Herbert T J, Fisher W E. Management of the fractured scaphoid using a new bone screw.  J Bone Joint Surg . 1984;  66B 114-123
  • 21 Russe O. Fracture of the carpal navicular: diagnosis, non-operative treatment, and operative treatment.  J Bone Joint Surg . 1960;  42A 759-768
  • 22 Warren-Smith C D, Barton N J. Non-union of the scaphoid: Russe graft versus Herbert screw.  J Hand Surg . 1988;  13B 83-86
    >