Scaphoid Fractures

Abstract

Scaphoid fractures can be a challenging injury to treat. They may not be recognized by the patient or health care provider initially. Thus, chronic scaphoid non-unions are relatively common. Factors that help determine treatment recommendations include presence or absence of arthritis, vascularity of proximal scaphoid, associated ligamentous injuries, time from injury, patient age, activity level, work requirements, smoking status, medical comorbidities, and patient reliability. Diagnostic work-up may include plain radiographs, computerized tomography (CT scan), and magnetic resonance imaging (MRI). Surgical planning includes dorsal vs. volar approach, need for supplemental bone graft, and type of fixation. Antegrade fixation placement through a dorsal approach is often used for acute, displaced proximal pole or waist fractures. Retrograde screw placement from a palmar approach is often used for distal third fractures or in chronic non-unions where a significant humpback deformity and/or bone loss is present and bone graft placement is necessary. This chapter describes in detail the use of non-vascularized cancellous only or structural corticocancellous bone graft with a palmar approach in conjunction with retrograde screw or wire fixation. Vascularized, pedicled rotational bone grafts from the distal radius or microvascular free grafts from the medial femoral condyle may be utilized in complex, chronic non-unions or proximal pole avascular necrosis. Associated ligamentous injuries and greater arc transscaphoid perilunate fracture-dislocations also occur but are beyond the scope of this chapter.