Nonunions of the scaphoid associated with proximal pole avascular necrosis (impaired blood supply) and acute proximal pole fractures have a high failure rates when treated with conventional techniques. A recent study from the Mayo Clinic in the Journal of Hand Surgery showed that smoking, failure to use screw fixation, and proximal fractures were all risk factors for persistent nonunion.
our microsurgical expertise makes performing vascularized bone grafts very feasible. In that light, this procedure, when indicated, is very feasible--and in my experience, the use of a screw and this type of graft result in successful outcome in greater than 80% of cases. It is important to note, however, that if the scaphoid fails to heal despite this intervention, additional surgery may become necessary in the future.
