Vascularized bone grafting and mini-acutrak fixation of scaphoid non-unions with avascular proximal pole

Objectives: We studied the use of vascularized bone graft as described by Zaidemberg et al. in combination with a fixation as described by Carter et al. in patients with scaphoid non-union and avascular proximal poles. We modified this method using a cannulated mini-acutrak screw. Methods: Between January 2006 and June 2010, we treated 12 male patients with symptomatic scaphoid non-union with avascular proximal poles. Their average age was 26 years (range 18-47 years). The average follow-up was 16 months (range 6-52 months). All the patients were assessed for any persistent pain including grade of pain, any restriction of daily activities, and osteoarthritis. Results: All patients achieved union within an average of 15 weeks (range 6-32 weeks). In all cases we encountered the 1, 2 intercompartmental supraretinacular artery (1, 2 ICSRA) intraoperative. X-rays and CT showed a complete osseous union in all patients. Conclusions: We have found that the technique described which combines vascularized bone graft with cannulated mini-acutrak screw, is reliable and successful in treating patients with scaphoid non-unions with avascular poles. We prefer to use the vessel described by Zaidemberg et al. as the 1, 2 ICSRA. If this vessel is occasionally absent (present in 94%), as noted by Sheetz et al., other pedicles may be used. © 2011 Elsevier Masson SAS.