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J Am Acad Orthop Surg, Vol 11, No 6, November/December 2003, 380-391.
© 2003 the American Academy of Orthopaedic Surgeons
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Management of Scaphoid Nonunions

Thomas E. Trumble, MD, Peter Salas, MD, Traci Barthel, MD and Kearny Q. Robert, III, MD

Dr. Trumble is Professor and Chief, Hand and Microvascular Surgery Service, University of Washington Medical Center, Seattle, WA. Dr. Salas is Fellow, Hand Surgery, Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle. Dr. Barthel is Fellow, Hand Surgery, Department of Orthopaedic Surgery and Sports Medicine, University of Washington. Dr. Robert is Fellow, Hand Surgery, Department of Orthopaedic Surgery and Sports Medicine, University of Washington.

Reprint requests: Dr. Trumble, University of Washington Medical Center, Box 356500, 1959 NE Pacific, Seattle, WA 98195.

Scaphoid nonunions result in a predictable pattern of wrist arthrosis. To minimize the incidence of arthrosis, the goal of treatment should be consolidation of the fracture with the scaphoid in anatomic alignment. Computed tomography and magnetic resonance imaging scans can aid evaluation of carpal collapse, scaphoid collapse, scaphoid nonunion, bone loss, and detection of osteonecrosis. Nonunion of the scaphoid waist may result in a humpback deformity, increasing the chances of further collapse and arthrosis. This collapse deformity must be approached volarly with an intercalary bone graft and internal fixation. A dorsal approach to proximal scaphoid nonunions allows easier access for removing the necrotic bone from the proximal pole and applying accurate screw or pin fixation. Vascularized bone graft is recommended to manage scaphoid nonunions with osteonecrosis.






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Copyright © 2003 by the American Academy of Orthopaedic Surgeons.