Minos Ε. Tyllianakis MD, PhD

Scaphoid nonunion is not a rare complication (see also “scaphoid fractures” in the same section). Manifestation of scaphoid fractures may be mild thus patients sometimes fail to ask for medical advice. In addition scaphoid fracturs may be overlooked in radiological examinations due to anatomical and physiological peculiarities and the situation runs undetected for years until a trivial injury causes disproportionally severe pain.

The more proximal the fracture the greater the chance to develop avascular necrosis of the proximal pole. That predisposes to nonunion.

Treatment of a scaphoid nonunion is always surgical – and demanding. The nonunion site is approached with dorsal or volar incision, depending on the site and configuration of the nonunion, debrided, the axis of scaphoid is restored and scaphoid is stabilized with a special screw or wires. Bone grafts are inserted into the nonunion site.

Supplementary distal radius closed wedge osteotomy may be performed. In cases of avascular nonunion vascularized grafts can be used to provide blood supply to the proximal pole. They are taken with microsurgical techniques from the distal part of the radius or from distant sites.