Russe bone graft procedure for Scaphoid Nonunion

June 1st, 2007

When a previous scaphoid fracture fails to heal, the nonunion is a potential source of chronic pain in the wrist. If the nonunion forms a significant cyst operative intervention may require bone graft. The Russe technique was popularized historically before the availability of compression screws, and had the advantage of union rates in excess of 80-85%.

Although many might instinctively select a screw and cancellous graft to treat a nonunited scaphoid without associated carpal instability, the Russe technique continues to have a role for this problem. I have found satisfactory healing rates when this procedure is used for large pseudoarthroses. This technique provides an in lay bone graft, which, itself, provides stability, and may even obviate the need for a screw.

During your evaluation, I will discuss whether and why this particular option might be best for you.

Related Photos:

Preoperative xray shows scaphoid nonunion. This patient had no DISI deformity

The scaphoid psuedarthrosis has been debrided in preparation for placement of the Russe graft

Graft has been placed into the scaphoid as an inlay, in combination with cancellous graft

Postoperative PA xray after union. Note that this technique allows for graft incorporation distally and proximally, but consolidation across the full width of the nonunion may not necessarily occur