Scaphoid Scaphoid: A Case Study

Scaphoid is the most commonly fractured carpus bone(1), and is the most commonly misdiagnosed fracture in the upper extremity(2). Regardless of the type of treatment, 25 to 45% progress towards non-union(3). Poor scaphoid vascularization and high mechanical forces explain these poor results. Factors associated with increased risk of non-union are proximal pole fractures, delay in diagnosis (> 6 weeks), inadequate immobilization(4), and smoking(5).

Scaphoid non-unions are rarely symptomatic in the early stages. However unmanaged scaphoid non-unions lead to progressive wrist arthritis(6), and the success rate of management decreases with the duration of the nonunion(7) .This with the inevitable development of arthritis shift treatment options to limited wrist fusions.
This philosophy has been extended to management of scaphoid waist nonunions that are nondisplaced and do not have evidence of significant sclerosis or bone loss at the fracture