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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 12, 1597-1601.
doi: 10.1302/0301-620X.90B12.20808  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The use of a vascularised periosteal patch onlay graft in the management of nonunion of the proximal scaphoid

N. W. Thompson, MPhil, FRCS(Trauma&Orth), Upper Limb Fellow1; A. Kapoor, MRCS, Clinical Research Fellow1; J. Thomas, FRACS, Upper Limb Fellow1; and M. J. Hayton, FRCS(Trauma&Orth), Consultant Hand Surgeon1

1 Centre for Hand and Upper Limb Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.

Correspondence should be sent to Mr M. J. Hayton; e-mail: mikehayton{at}gmail.com

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.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General