Journal List > J Korean Soc Surg Hand > v.19(4) > 1106467

J Korean Soc Surg Hand. 2014 Dec;19(4):173-179. Korean.
Published online December 31, 2014.
Copyright © 2014. The Korean Society for Surgery of the Hand
Scaphoid Nonunions Treated with 1, 2-Intercompartment Supraretinacular Artery Pedicled Vascularized Bone Graft and Headless Compression Screw Fixation
Dong-Hyun Kim, Yang-Guk Chung, Seung-Han Shin, Ho-Jin Gil, Jin-Woo Kang and Han-Seok Cho
Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Yang-Guk Chung. Department of Orthopedic Surgery, Seoul St. Mary' Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. TEL: +82-2-2258-2837, FAX: +82-2-535-9834, Email:
Received November 19, 2014; Revised December 08, 2014; Accepted December 09, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The purpose of this study was to evaluate the clinical results of scaphoid nonunions treated with 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone grafting (VBG) and headless compression screw fixation.


Since August 1, 2005, 11 scaphoid nonunions with avascular necrosis or bone marrow edema of proximal fragments were managed with 1, 2-ICSRA pedicled VBG combined with headless compression screw fixation. The mean age was 37.1 years (range, 21-66 years). 8 patients had avascular necrosis (AVN) of proximal fragments and 3 patients had bone marrow edema in proximal fragments. Serial radiographic evaluations were performed in every 4-8 weeks for bone union and follow up computed tomography scanning were checked in 8 patients.


Bone unions were obtained in all 11 patients at 4.9 months (range, 3-9 months) after operation. At last follow up, the average range of motion was 82.5% and the grip power was 84.1% compared to the contralateral side. The mean New York Orthopaedic Hospital wrist score at last follow up was 83.2 (range, 58.1-93.3).


Combined 1, 2-ICSRA pedicled VBG and headless compression screw fixation were reliable methods for managements of scaphoid nonunions even with AVN at proximal fragments.

Keywords: Scaphoid nonunion; Avascular necrosis; 1, 2-Intercompartment supraretinacular artery pedicled vascularized bone graft; Headless compression screw fixation


Fig. 1
Technique of 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone graft using a dorsal approach for scaphoid nonunions. (A) The 1, 2-ICSRA pedicled vascularized bone graft was elevated from the dorsal surface of distal radius. The perfusion status of elevated bone graft was confirmed after tourniquet release. (B) After headless compression screw fixation, a slot for pedicled vascularized bone graft was prepared at dorsal surface of scaphoid with osteotome and curet.
Click for larger image

Fig. 2
The patient with a complaining of right wrist pain for 1 year. (A) The radiograph showed nonunion & sclerotic change of scaphoid proximal pole. (B) Magnetic resonance imaging showed avascular necrosis of proximal pole of scaphoid. (C) Headless compression screw fixation and 1, 2-intercompartment supraretinacular artery pedicled vascularized bone graft were performed. (D) At postoperative 3 months, complete bone union has progressed.
Click for larger image

Fig. 3
The patient has been complaining with a right wrist pain for 1 year. (A) The radiograph showed scaphoid nonunion and sclerotic change. (B) Magnetic resonance imaging showed bone marrow edema of whole proximal fragment and large portion of distal fragment of scaphoid, which suggested precarious perfusion status. (C) 1, 2-intercompartment supraretinacular artery pedicled vascularized bone graft and headless compression screw fixation were performed. (D) At postoperative 12 months, computed tomography scan revealed progression of bone union and no more scaphoid collapse.
Click for larger image


Table 1
Summary of cases (ROM, grip power, NYOH score, Green-O'Brien score and radiologic results)
Click for larger image


*This paper was introduced at 2013 Annual Meeting of the Korean Orthopaedic Association.

1. Cooney WP 3rd, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg Am 1980;5:343–354.
2. Cooney WP, Linscheid RL, Dobyns JH, Wood MB. Scaphoid nonunion: role of anterior interpositional bone grafts. J Hand Surg Am 1988;13:635–650.
3. Tomaino MM, King J, Pizillo M. Correction of lunate malalignment when bone grafting scaphoid nonunion with humpback deformity: rationale and results of a technique revisited. J Hand Surg Am 2000;25:322–329.
4. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am 1985;10:597–605.
5. Pokorny JJ, Davids H, Moneim MS. Vascularized bone graft for scaphoid nonunion. Tech Hand Up Extrem Surg 2003;7:32–36.
6. Shin AY, Bishop AT. Pedicled vascularized bone grafts for disorders of the carpus: scaphoid nonunion and Kienbock's disease. J Am Acad Orthop Surg 2002;10:210–216.
7. Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am 1991;16:474–478.
8. Nakamura R, Imaeda T, Horii E, Miura T, Hayakawa N. Analysis of scaphoid fracture displacement by threedimensional computed tomography. J Hand Surg Am 1991;16:485–492.
9. McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br 2008;90:66–71.
10. Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am 1951;33:895–907.
11. Smith BS, Cooney WP. Revision of failed bone grafting for nonunion of the scaphoid. Treatment options and results. Clin Orthop Relat Res 1996;(327):98–109.
12. Rajagopalan BM, Squire DS, Samuels LO. Results of Herbert-screw fixation with bone-grafting for the treatment of nonunion of the scaphoid. J Bone Joint Surg Am 1999;81:48–52.
13. Park MJ, Lee JS, Shin SK. Treatment of scaphoid nonunionusing a pedicled vascularized bone graft. J Korean Orthop Assoc 2006;41:871–876.
14. Jones DB Jr, Burger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg Am 2008;90:2616–2625.
15. Malizos KN, Dailiana ZH, Kirou M, Vragalas V, Xenakis TA, Soucacos PN. Longstanding nonunions of scaphoid fractures with bone loss: successful reconstruction with vascularized bone grafts. J Hand Surg Br 2001;26:330–334.
16. Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am 2000;25:507–519.
17. Boyer MI, von Schroeder HP, Axelrod TS. Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg Br 1998;23:686–690.
18. Gunal I, Ozcelik A, Gokturk E, Ada S, Demirtas M. Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion. Arch Orthop Trauma Surg 1999;119:285–287.
19. Schmitt R, Heinze A, Fellner F, Obletter N, Struhn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol 1997;25:92–103.