A new vascularized cartilague-bone-graft for scaphoid nonunion with avascular necrosis of the proximal pole.: Description of a new type of surgical procedure

The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a dreaded complication after conservative or operative treatment of a scaphoid bone fracture, which previously often led to partial or total stiffening operations on the wrist. Vascularized bone grafts can be used to increase the bone fusion rates in the presence of scaphoid pseudarthrosis with avascular necrosis. On a note of caution, it must be mentioned, though, that such a procedure in the presence of avascular necrosis of the proximal pole with destruction of cartilage can lead to premature radiocarpal arthritis, because a friction-free gliding in the area of the proximal scaphoid pole is no longer ensured as a result of the lacking cartilage cover. We confronted these problems in a 20-year-old male patient with avascular necrosis of the proximal scaphoid bone pole and destruction of the corresponding scaphoidal cartilage cover. We transplanted a free vascularized cartilage-bone graft from the medial femoral condyle, which was adapted in form and size to the proximal scaphoid bone pole with corresponding cartilage cover and was connected to the radial vascular bundle. This novel operation technique is described in this report and appears to be a promising way of avoiding premature radiocarpal arthritis when treating scaphoid bone pseudo-arthrosis with avascular necrosis in the presence of cartilage destruction.