Percutaneous management of scaphoid nonunions

Scaphoid nonunions pose a formidable challenge to surgeons because of the multiple factors that may contribute to their causation. The etiology of the nonunion may be because of anatomic variations, fracture configuration, vascular problems, underlying metabolic problems, or the inadequacy of initial treatment. Percutaneous management of scaphoid nonunions offers the advantage of inducing minimal trauma to the soft tissues while adequately stabilizing the fracture site to induce union in a high percentage of cases. These minimally invasive techniques of fixation can also be combined with arthroscopy and some of the new biologic bone grafting techniques. The indications, advantages, and techniques of the dorsal and volar percutaneous approaches are described in this paper.