Scaphoid nonunion can cause pain, loss of wrist motion, and loss of grip strength. Because initial roentgenograms are not always definitive, patients suspected of having a scaphoid fracture despite negative initial radiographs should undergo bone scan. Treatment of acute nondisplaced fracture of the scaphoid generally nonoperative, involving immobilization in a cast. Treatment of scaphoid nonunion is generally operative, and many procedures and their associated risks are reviewed. There is no consensus about the clinical implications of scaphoid malunion.
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Femoral Trochlea Osteochondral Autograft Transplant for Scaphoid Proximal Pole Nonunions.
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March 2025
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Small proximal pole scaphoid nonunions are challenging to treat. We describe a technique for replacing the proximal pole fragment with an osteochondral autograft transplant harvested from the ipsilateral femoral trochlea. This is indicated in nonunions where the proximal pole fragment is smaller than the scaphoid isthmus; the scapholunate ligament complex is intact on the distal fragment, and in nonunions without dorsal intercalated segment instability and radiocarpal arthritis.
View Article and Find Full Text PDFCan we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial.
J Orthop Traumatol
March 2025
Department of Orthopaedics and Sport Medicine, Erasmus MC University Medical Center, PO box 2040, 3000 CA, Rotterdam, The Netherlands.
Background: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes.
Patients And Methods: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial.
The role of surgical timing in 124 scaphoid nonunion surgical procedures.
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February 2025
Department of Hand Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
A total of 124 scaphoid nonunion surgical procedures performed between 2002 and 2020 were analyzed to investigate the potential impact of delayed diagnosis on time to union. The primary outcome was the correlation between the time from injury to surgery and the time to union. Secondary outcomes included identifying risk factors for delayed union and persistent nonunion following scaphoid nonunion surgery.
View Article and Find Full Text PDFObjectives: Non-repairable scaphoid proximal pole nonunion remains a major challenge. Various reconstructive surgical approaches have been introduced, but each one has some limitations, including microvascular anastomosis, donor site morbidities, and the risk of compromising the scapholunate ligament.
Methods: This prospective interventional case series was performed on five patients.
Vascularized Versus Non-vascularized Bone Grafting for Scaphoid Non-union: A Meta-Analysis.
Cureus
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Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, IND.
Non-union after scaphoid fracture is a common complication. Controversy exists regarding the efficacy of vascularized bone graft (VBG) versus non-vascularized bone graft (NVBG) for scaphoid non-union. In the current meta-analysis, a comprehensive search of PubMed and the Cochrane Library database was done from inception to June 2024.
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