Scaphoid Nonunion


A scaphoid nonunion occurs in untreated scaphoid fractures and in scaphoid fractures that fail to show signs of healing after 3 months of cast treatment. Initial scaphoid fractures usually occur as isolated injuries, but they can occur in combination with other extremity injuries that mask the pain and swelling at the wrist. Diagnosis of scaphoid nonunion is based on patient history, physical examination, and imaging studies. The standard of treatment consists of internal fixation and bone grafting the scaphoid. This article reviews the pathophysiology and clinical presentation of scaphoid nonunion and reviews the considerations in surgical management. Specific surgical techniques reviewed in detail include palmar approach, dorsal approach, and vascularized bone graft.

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