Scaphoid Nonunion

Scaphoid nonunion is a failure of a fracture of the scaphoid to heal properly. The scaphoid bone is one of the bones in the wrist and can be fractured during falls onto an outstretched hand. When fractured, the blood supply to the scaphoid is often disrupted and if the fracture fails to unite through casting or surgery, a nonunion occurs. If untreated, a scaphoid nonunion can lead to severe arthritis of the wrist and severe wrist pain. Other symptoms may include weakness, stiffness, and swelling in the wrist.

Scaphoid nonunions are diagnosed through patient history, physical examination, and x-ray and MRI imaging. A history of previous scaphoid fracture and pain is characteristic of a scaphoid nonunion. Tenderness in the anatomical snuffbox may also be helpful in scaphoid nonunion diagnosis. Treatment for scaphoid nonunion requires surgery and aims to restore scaphoid alignment and heal the bone. There are two basic surgical approaches for open reduction and internal fixation of scaphoid nonunions, one from the dorsal side and one from the palmar side. Surgical treatment will generally require pins or screws to correct the nonunion and restore scaphoid alignment. Additionally, bone grafting may be required. Bone grafts may be avascularized (without blood supply) or vascularized (with blood supply). After surgery and once the scaphoid has healed, patients will work with an occupational therapist to regain strength and mobility of the wrist. Patients should expect recovery in about 12 weeks or longer.

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