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J Wrist Surg 2026; 15(01): 002-007
DOI: 10.1055/s-0044-1782230
Special Symposium: Scaphoid Nonunion Treatments

Nonvascularized Bone Grafting for Scaphoid Nonunion

Authors

  • Viviana M. Serra López 

    1   Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York

  • Scott W. Wolfe

    1   Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York

Funding None declared.
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Abstract

Background

Surgical management of scaphoid nonunions requires not only stable fixation but restoration of carpal alignment and reconstruction of bone defects. The latter can be done with either vascularized or non-vascularized bone grafts, depending largely on surgeon preference.

Materials and Methods

This article describes the use of non-vascularized bone grafts for scaphoid nonunions and examines reported outcomes. We also describe the senior author's preferred surgical treatment, the hybrid Russe procedure.

Description of Technique

The hybrid Russe procedure utilizes a corticocancellous strut from the volar aspect of the distal radius to restore anatomy in scaphoid nonunions with flexion deformities. Once the alignment of the scaphoid and associated lunate postural deformities are corrected, fixation then proceeds with a headless compression screw. This combination resulted in healing of 17 scaphoid fracture nonunions at an average time of 15 weeks.

Conclusions

The literature does not demonstrate a difference in union rates when comparing the use of vascularized and non-vascularized grafts for scaphoid nonunions. When the proximal pole of the scaphoid can be salvaged, the choice of fixation is left to the surgeon's discretion.

Keywords

scaphoid non-union - hybrid Russe - nonvascularized bone graft


Publication History

Received: 10 December 2023

Accepted: 13 February 2024

Article published online:
21 March 2024

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