Recent methods for treatment of scaphoid nonunion

Abstract

The scaphoid is the largest bone of proximal carpal row and acts as an important stabilizing link between the proximal and distal rows. The scaphoid receives the majority of its blood supply via dorsal vessels at or just distal to the waist area, these vessels perfuse the proximal pole in a retrograde fashion (from distal to proximal). This explains the problems of delayed union and non-union with fractures of the proximal pole of the scaphoid. Fractures of the scaphoid represent nearly 2% of all fractures. Fractures of the scaphoid comprise 70% to 80% of injuries to the carpal bones. Despite adequate non-operative treatment, scaphoid fracture nonunion occurs at a rate of 3% to 10%. Established scaphoid non-unions have been successfully treated with a variety of surgical procedures. The described treatments for these non-union include, pulsed electromagnetic field and casting, Russe bone grafting, iliac bone grafting and fixation either by K-wire, lag screw, or Herbert screw, compression staple osteosynthesis, pronator quadratus vascular graft, Ilizarov distraction/compression technique ,and distal dorsal and volar radial vascular graft. Salvage and palliative procedures considered if the proximal fragment constitutes less than one fifth of the bone, regardless of its viability and if there is capitolunate arthritis. They include proximal raw carpectomy, excision of the entire carpal scaphoid, excision of the proximal fragment, and scaphoid replacement midcarpal arthrodesis. Key words: Scaphoid Non-union Instability Bone grafting Arthritis Arthrodesis