Advances in the Treatment of Scaphoid Nonunions


Surgeons can directly impact the success of treating patients with scaphoid nonunion by separating waist nonunions from proximal pole nonunions. Most proximal pole nonunions have osteonecrosis, and in such situations a dorsal approach combined with vascularized bone grafting provides a reasonable treatment option. For patients with scaphoid waist nonunion, the surgeon must determine whether or not there is osteonecrosis and/or a collapse deformity. In the rare event that no collapse is present, the nonunion can be treated using a volar approach or dorsal approach with or without a vascularized bone graft, depending on the presence of osteonecrosis. If collapse is present, then use of a volar approach is necessary, combined with a volar rotation of a vascularized bone graft supplied by the 1,2- intercompartmental supraretinacular artery if osteonecrosis is present.

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