Traditional Bone Grafting in Scaphoid Nonunion

Scaphoid nonunion remains a difficult problem for the hand surgeon. Attention to technical details is likely of greater importance than bone graft choice in achieving union and in overall functional outcome of the patient. Aggressive debridement before grafting is often glossed over, as this is a difficult factor to evaluate, but the authors believe it to be the most critical step in the operation. Correction of scaphoid collapse, although not necessary to achieve union, improves postoperative wrist function and may be achieved with either corticocancellous or cancellous grafting. When cancellous grafting is used, pairing with a compression screw may help hold the reduction. Rigid fixation remains important, and union may be achieved with either K-wires or compression screws. As always with surgery, patient selection is crucial; in those with diminutive or fragmented proximal poles, or other risk factors for recurrent nonunion such as smoking status or increased time from injury, replacement with a vascularized bone flap should be considered. Studies on scaphoid nonunions will remain limited until there are standardized criteria for describing fracture location, outcomes in wrist motion, definition of union, and modality to assessing union.

Automated summary

Scaphoid nonunion remains a challenging problem for hand surgeons, and attention to technical details is crucial. Aggressive debridement before grafting is considered the most critical step in the operation. Repairing scaphoid collapse can improve postoperative wrist function, although it is not necessary for achieving union.