Extremely longstanding neglected scaphoid nonunion with humpback deformity treated with a palmar radiocarpal artery vascularized bone graft: A report of two cases

Scaphoid nonunion (SN) with humpback deformity (HD) may be treated with varying approaches, and there is no consensus regarding the optimal method for longstanding neglected cases. We present two cases of extremely longstanding neglected SN with HD, both successfully treated with palmar radiocarpal artery (PRCA) vascularized bone grafts (VBGs). Two patients, aged 55 and 58 years, who experienced injury 40 and 23 years prior, respectively, presented with neglected SN with HD and underwent surgery. Using a palmar approach, the nonunion site was decorticated and PRCA-VBGs were intercalated and fixed with headless screws. Partial union was confirmed by computed tomography within 3 months postoperatively, and satisfactory clinical and radiographic outcomes were observed at the final follow-up. The method facilitated correction of HD with VBGs from the palmar side of the distal radius. PRCA-VBGs may be suitable for achieving bone union and deformity correction in extremely longstanding cases.