[Scaphoid malunion]

Scaphoid fracture and healing are often difficult to diagnose. The scaphoid bone may heal in an abnormal position and this malunion is usually in flexion and shortening. Fractures of the mid or distal part of the bone are mainly concerned. This malunion may be the cause of an alteration of the carpal mechanics and finally of osteoarthritis revealed by pain and decrease of motion and strength. The intrascaphoid angle of Amadio helps to calculate the magnitude of the deformity and to plan the correction. This malunion has to be corrected only if symptomatic. Two other types of malunions exist: healing with a rotation of the distal fragment, and healing with irregular contours which may also lead to arthritis. Correction of the malunion will be performed after having assessed precisely measurements of the deformity using comparative X-rays, special views, carpal indices and eventually a dedicated specific software. In the literature may be found a certain number of papers where scaphoid osteotomy combined with a trapezoidal bone graft and a bone fixation using a screw have been performed with success and healing for all cases. This procedure may be performed without hesitation for a symptomatic healed scaphoid, even if it has been operated before for nonunion.