Zaidemberg et al. describe a pedicled vascularized bone graft from the dorsoradial distal radius for scaphoid nonunion. The graft is based on a retrograde radial artery branch, first characterized in 10 cadaver dissections (20 wrists), then applied in 11 patients with long-standing nonunion. The study asks whether this technique can achieve union faster and in cases where conventional grafting has already failed.
The scaphoid proximal pole gets its blood supply in a retrograde fashion. After fracture or nonunion, that supply is tenuous — and conventional avascular grafting still fails in up to 10% of cases, requiring months of immobilization even when it works.
When you see a scaphoid nonunion with proximal pole sclerosis, cystic changes, or a prior failed bone graft, the Zaidemberg graft is the appropriate next step. The pedicle is a retrograde radial artery branch running deep to the first dorsal extensor compartment, sitting reliably on the dorsoradial distal radius in every patient.
During harvest, protect the dorsal sensory branch of the radial nerve. Post-op: long arm thumb spica for 1 month, then short arm thumb spica for 2 weeks. Start motion only after confirmed union on X-ray or tomogram at 6 weeks.
This paper established the anatomic and clinical foundation for the 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) graft. Now the standard pedicled vascularized option for proximal pole nonunion with AVN.
Zaidemberg et al. describe a pedicled vascularized bone graft from the dorsoradial distal radius for scaphoid nonunion. The graft is based on a retrograde radial artery branch, first characterized in 10 cadaver dissections (20 wrists), then applied in 11 patients with long-standing nonunion. The study asks whether this technique can achieve union faster and in cases where conventional grafting has already failed.
The scaphoid proximal pole gets its blood supply in a retrograde fashion. After fracture or nonunion, that supply is tenuous — and conventional avascular grafting still fails in up to 10% of cases, requiring months of immobilization even when it works.
When you see a scaphoid nonunion with proximal pole sclerosis, cystic changes, or a prior failed bone graft, the Zaidemberg graft is the appropriate next step. The pedicle is a retrograde radial artery branch running deep to the first dorsal extensor compartment, sitting reliably on the dorsoradial distal radius in every patient.
During harvest, protect the dorsal sensory branch of the radial nerve. Post-op: long arm thumb spica for 1 month, then short arm thumb spica for 2 weeks. Start motion only after confirmed union on X-ray or tomogram at 6 weeks.
This paper established the anatomic and clinical foundation for the 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) graft. Now the standard pedicled vascularized option for proximal pole nonunion with AVN.