J Korean Fract Soc.
2022 Oct;35(4):182-189. 10.12671/jkfs.2022.35.4.182.
Treatment of Scaphoid Fractures and Nonunions
- Affiliations
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- 1Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
- KMID: 2534407
- DOI: http://doi.org/10.12671/jkfs.2022.35.4.182
Abstract
- A scaphoid fracture is one of the most common types of wrist fractures, and if treatment is delayed, there is a high possibility of nonunion due to anatomical factors such as limited blood supply to the injured bone. Therefore, it is important to suspect a scaphoid fracture based on the mechanism of wrist injury and physical examination of the patient. A computed tomography scan or magnetic resonance imaging can also aid early diagnosis of the fracture. Stable acute fractures can be treated conservatively, but unstable fractures require surgical treatment, and percutaneous screw fixation is usually performed. Nonunions require bone grafts and are treated with non-vascularized bone grafts and screw fixation. However, if the nonunion is located at the proximal pole, a vascularized bone graft may be considered because there is a possibility of avascular necrosis. Pedicled vascularized and free vascularized medial femoral condyle bone grafts are mainly used in such cases. The treatment of a proximal pole nonunion with impaired blood flow remains controversial. There are conflicting opinions on whether a nonvascularized bone graft is sufficient or whether a vascularized bone graft is necessary.
