Gelberman and Menon used latex injection and clearing techniques in 15 cadaver forearms to map the complete extraosseous and intraosseous blood supply of the scaphoid. The goal was to explain the bone's unusually high rate of avascular necrosis after fracture and to identify the least destructive operative approach.
The scaphoid is second only to the femoral head in post-traumatic AVN rate — and this paper explains exactly why. Before Gelberman's work, the vascular anatomy was contested, with some authors believing the proximal pole received direct vessel supply through the scapholunate ligament. This study proved those ligament vessels never penetrate the cortex: the proximal pole lives or dies entirely based on dorsal ridge entry vessels in the distal half of the bone.
When you see a waist or proximal-pole scaphoid fracture, remember: 73% of specimens have their feeding vessels at or distal to the waist, making ischemia the rule rather than the exception after displacement. This anatomy is why proximal-fifth fractures approach 100% AVN. The fracture line is proximal to every single nutrient foramen.
For operative planning, the volar approach is preferred precisely because it leaves the dorsal ridge untouched, preserving the one vascular pedicle the proximal fragment has. This is the anatomic rationale behind the Russe volar bone graft technique and the modern preference for volar percutaneous fixation when approaching the scaphoid surgically.
Gelberman and Menon used latex injection and clearing techniques in 15 cadaver forearms to map the complete extraosseous and intraosseous blood supply of the scaphoid. The goal was to explain the bone's unusually high rate of avascular necrosis after fracture and to identify the least destructive operative approach.
The scaphoid is second only to the femoral head in post-traumatic AVN rate — and this paper explains exactly why. Before Gelberman's work, the vascular anatomy was contested, with some authors believing the proximal pole received direct vessel supply through the scapholunate ligament. This study proved those ligament vessels never penetrate the cortex: the proximal pole lives or dies entirely based on dorsal ridge entry vessels in the distal half of the bone.
When you see a waist or proximal-pole scaphoid fracture, remember: 73% of specimens have their feeding vessels at or distal to the waist, making ischemia the rule rather than the exception after displacement. This anatomy is why proximal-fifth fractures approach 100% AVN. The fracture line is proximal to every single nutrient foramen.
For operative planning, the volar approach is preferred precisely because it leaves the dorsal ridge untouched, preserving the one vascular pedicle the proximal fragment has. This is the anatomic rationale behind the Russe volar bone graft technique and the modern preference for volar percutaneous fixation when approaching the scaphoid surgically.