The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion.

This article reports a prospective study of 45 patients with nonunion of the scaphoid treated with Russe bone grafting. The operative procedure contains modifications in the technique made by Russe subsequent to his 1960 article. The results strongly support Russe's contention that his operation is not likely to be successful if the proximal pole is totally avascular. Twenty-four (92%) of 26 patients with good vascularity in the proximal pole achieved solid union. In patients in whom the vascularity of the proximal pole was spotty or diminished, the rate of union dropped to 71% (10 of 14). Most important, none of the five patients in whom the proximal pole was totally avascular achieved successful union. True avascular necrosis is best determined by punctate bleeding points in cancellous bone found at operation, and cannot be accurately predicted by the appearance of preoperative radiographs.