Minos Ε. Tyllianakis MD, PhD

Scaphoid nonunion is not a rare complication (see also “scaphoid fractures” in the same section). Scaphoid fracturs are usually overlooked due to anatomical and physiological peculiarities of the scaphoid or because of negligence on the part of the patients.

Complaints of a scaphoid fracture being usually mild the patient fails to seek for a medical advice. Moreover, peculiarities in anatomy and physiology of that bone may predispose to nonunion. The situation runs usually undetected until years after the initial injury, when the patient progressively experiences pain at the wrist motion and decrease in grip strength.

The more proximal the fracture the greater the chance to develop avascular necrosis of the proximal pole too, due to interruption of the blood supply. That gravely affects treatment of nonunion.

Treatment of a scaphoid nonunion is always surgical. The nonunion site is approached with dorsal or volar incision, depending on the site and configuration of the nonunion, cleaned, the axis of scaphoid is restored and scaphoid is stabilized with a special screw or wires. Bone grafts are inserted into the nonunion site.

Supplementary distal radius closed wedge osteotomy may be performed. In cases of avascular nonunion vascularized grafts must be used in order to provide blood supply to the central pole. They are taken with microsurgical techniques from the distal part of the radius.