Fractures and nonunions of the scaphoid

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. Scaphoid nonunion often complicates scaphoid fractures especially if the diagnosis is missed initially, and adequate timely treatment is not provided. Displaced unstable fractures also have a tendency to develop nonunion. The tenuous vascular anatomy of the scaphoid, the inherent biomechanical instability of scaphoid fractures, and the difficulty of radiographic diagnosis are the culprits of nonunion. Established scaphoid nonunion is a challenging and difficult problem to treat and more so is the treatment of failed nonunion after grafting. New methods of diagnosis and treatment of scaphoid injuries are constantly evolving. One common method of treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Early diagnosis and attention to details of surgical technique are necessary for successful treatment outcome. The purpose of this report is to review the basic science, diagnosis, and treatment of scaphoid fractures and nonunions.