Successful treatment of pediatric scaphoid nonunion with a vascularized bone graft: A report of four cases

Scaphoid fractures are rare in children, and the occurrence of nonunion is even more uncommon. While vascularized bone grafting (VBG) has been shown to be effective in adult scaphoid nonunion, the commonly used distal radius VBG carries a risk of growth plate injury in pediatric patients. This study reports the outcomes of VBG from the second metacarpal base for scaphoid nonunion in teenagers with open epiphysial line. Since 2001, we treated four pediatric patients (≤14 years) with scaphoid nonunion using second metacarpal VBG. Grafts were harvested from the second metacarpal base, preserving the dorsal metacarpal artery, and fixed with headless screws and K-wires. Bone union was achieved in all cases. Although one case showed incomplete correction of DISI deformity, all patients had favorable outcomes in terms of range of motion and Mayo Wrist Scores. Second metacarpal VBG achieved bone union and good function in pediatric scaphoid nonunion. Nonetheless, the potential limitations in correcting DISI deformity should be considered.