Diagnosis
Xray
- sclerosis
CT
MRI
- probably the most sensitive and specific
Bone Graft v Vascularised bone graft
Merrell J Hand Surg Am 2002
- meta-analysis
1. Bone graft with proximal pole AVN
- union 50%
2. Vascularised bone graft with proximal pole AVN
- union 88%
Vascularised bone grafting / VBG
1. Pronator quadratus pedicle graft
- much less common now
2. Vascularised distal radius graft / Zaidemberg
- most common
3. 2nd metacarpal graft
- very common
Technique Zaidemberg
Dorso-radial approach
- 1/2 intercompartmental supraretinacular branch of the radial artery
- travels distal to proximal
- between tendons of the first and second extensor compartments
- can use 2/3 if 1/2 small or missing
- follow to distal radius
- osteotome 3 sides preserving pedicle
Dorsal approach to scaphoid
- open non union site
- insert VBG
- fixation with screw