The Effect of Bone Grafts with and without Vascular Base in the Treatment of Scaphoid Non-Unions

As we delve deeper into the intricate world of scaphoid non-unions and bone grafting, we embark on a journey of scientific inquiry and surgical innovation, aiming to shed light on the most effective strategies to restore function, alleviate pain, and enhance the quality of life for patients grappling with this challenging condition. Join us on this intellectual voyage as we unravel the mysteries surrounding the treatment of scaphoid non-unions and the critical role that bone grafts, with or without a vascular base, play in this intricate puzzle of orthopedic care. We initiated a prospective randomized study with the aim of comparing clinical, functional, and radiographic outcomes among 80 patients subjected to treatment for scaphoid nonunion using vascularized bone grafts harvested from the dorsal and distal aspects of the radius (designated as group I). This was juxtaposed with the treatment of 40 patients who received conventional non-vascularized bone grafts harvested from the distal radius (group II). During surgical intervention, we encountered 30 cases of sclerotic, inadequately vascularized scaphoids in group I, in contrast to 20 cases in group II. The results of our study unveiled a striking discrepancy in bone fusion rates, with 89.1% of patients in group I achieving successful fusion compared to 72.5% in group II (p = 0.024). In summary, our findings strongly support the utilization of vascularized bone grafts, especially in cases involving sclerotic and poorly vascularized proximal poles in patients with scaphoid nonunion. This approach not only yields superior results but also proves to be more efficient in promoting bone fusion and enhancing functional outcomes.