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Nonunions of the Wrist and Hand

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Nonunions

Abstract

Nonunions of the wrist and hand present a challenging problem with continually evolving treatment modalities. Appropriate evaluation of the nonunited wrist or hand fracture, identification of the causal factors leading to nonunion, and subsequent choice of intervention are critical to providing a functional and painless extremity. This chapter will discuss nonunions of the wrist and hand, their sequelae, and treatment options ranging from reconstructions to salvage procedures.

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References

  1. Fernandez DL, Ring D, Jupiter JB. Surgical management of delayed union and nonunion of distal radius fractures. J Hand Surg Am. 2001;26(2):201–9.

    Article  CAS  PubMed  Google Scholar 

  2. Segalman KA, Clark GL. Un-united fractures of the distal radius: a report of 12 cases. J Hand Surg Am. 1998;23(5):914–9.

    Article  CAS  PubMed  Google Scholar 

  3. Wolfe SW. Distal radius fractures. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2010. p. 561–638.

    Google Scholar 

  4. McKee MD, Waddell JP, Yoo D, Richards RR. Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases. J Orthop Trauma. 1997;11(1):49–53.

    Article  CAS  PubMed  Google Scholar 

  5. Prommersberger KJ, Fernandez DL, Ring D, Jupiter JB, Lanz UB. Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result? Chir Main. 2002;21(2):113–23.

    Article  CAS  PubMed  Google Scholar 

  6. Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg. 1997;5(5):270–81.

    Article  CAS  PubMed  Google Scholar 

  7. Ring D, Prommersberger KJ, Gonzalez del Pino J, Capomassi M, Slullitel M, Jupiter JB. Corrective osteotomy for intra-articular malunion of the distal part of the radius. J Bone Joint Surg Am. 2005;87(7):1503–9.

    PubMed  Google Scholar 

  8. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br. 1996;78(4):588–92.

    Article  CAS  PubMed  Google Scholar 

  9. Leslie BM, Medoff RJ. Fracture specific fixation of distal radius fractures. Tech Orthop. 2000;15:336–52.

    Article  Google Scholar 

  10. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279–88.

    Article  PubMed  Google Scholar 

  11. Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am. 1984;15(2):217–36.

    PubMed  Google Scholar 

  12. Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, Simpson H, Alt V. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45(Suppl 2):S3–7.

    Article  PubMed  Google Scholar 

  13. Bushnell BD, Bynum DK. Malunion of the distal radius. J Am Acad Orthop Surg. 2007;15(1):27–40.

    Google Scholar 

  14. Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper-extremity performance. J Hand Surg Am. 2003;28(6):898–903.

    Article  PubMed  Google Scholar 

  15. Prommersberger KJ, Fernandez DL, Ring D, Jupiter JB, Lanz UB. Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result? Chir Main. 2002;21(2):113–23.

    Article  CAS  PubMed  Google Scholar 

  16. Ring D. Nonunion of the distal radius. Hand Clin. 2005;21(3):443–7.

    Article  PubMed  Google Scholar 

  17. Gwathmey FW Jr, Brunton LM, Pensy RA, Chhabra AB. Volar plate osteosynthesis of distal radius fractures with concurrent prophylactic carpal tunnel release using a hybrid flexor carpi radialis approach. J Hand Surg Am. 2010;35(7):1082–8.

    Article  PubMed  Google Scholar 

  18. Ring D, Jupiter JB. Nonunion of the distal radius. Tech Hand Up Extrem Surg. 2002;6(1):6–9.

    Article  PubMed  Google Scholar 

  19. Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am. 2004;86-A(9):1900–8.

    Google Scholar 

  20. Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am. 2009;91(1):55–65.

    Google Scholar 

  21. Jupiter JB, Fernandez DL. Complications following distal radial fractures. J Bone Joint Surg Am. 2001;83:1244–65.

    Article  Google Scholar 

  22. Bakker AJ, Shin AY. Fragment-specific volar hook plate for volar marginal rim fractures. Tech Hand Up Extrem Surg. 2014;18(1):56–60.

    Article  PubMed  Google Scholar 

  23. Mithani SK, Srinivasan RC, Kamal R, Richard MJ, Leversedge FJ, Ruch DS. Salvage of distal radius nonunion with a dorsal spanning distraction plate. J Hand Surg Am. 2014;39(5):981–4.

    Article  PubMed  Google Scholar 

  24. Hanel DP, Ruhlman SD, Katolik LI, Allan CH. Complications associated with distraction plate fixation of wrist fractures. Hand Clin. 2010;26(2):237–43.

    Article  PubMed  Google Scholar 

  25. Stucken C, Olszewski DC, Creevy WR, Murakami AM, Tornetta P. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg Am. 2013;95(15):1409–12.

    Article  PubMed  Google Scholar 

  26. Jones AL, Bucholz RW, Bosse MJ, Mirza SK, Lyon TR, Webb LX, et al; BMP-2 Evaluation in Surgery for Tibial Trauma-Allgraft (BESTT-ALL) Study Group. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(7):1431–41.

    Google Scholar 

  27. Aro HT, Govender S, Patel AD, Hernigou P, Perera de Gregorio A, Popescu GI, Golden JD, Christensen J, Valentin A. Recombinant human bone morphogenetic protein-2: a randomized trial in open tibial fractures treated with reamed nail fixation. J Bone Joint Surg Am. 2011;93(9):801–8.

    Article  PubMed  Google Scholar 

  28. Adams BD. Distal radioulnar joint. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2010. p. 523–60.

    Google Scholar 

  29. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002;27(6):965–71.

    Article  PubMed  Google Scholar 

  30. Ekenstam F. Anatomy of the distal radioulnar joint. Clin Orthop Relat Res. 1992;(275):14–8.

    Google Scholar 

  31. Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am. 2002;27(2):243–51.

    Article  PubMed  Google Scholar 

  32. Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am. 2000;25(4):689–99.

    Article  CAS  PubMed  Google Scholar 

  33. Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996;21(5):587–94.

    Article  CAS  PubMed  Google Scholar 

  34. Wallwork NA, Bain GI. Sigmoid notch osteoplasty for the chronic volar instability of the distal radioulnar joint: a case report. J Hand Surg Am. 2001;26(3):454–9.

    Article  CAS  PubMed  Google Scholar 

  35. Sagerman SD, Zogby RG, Palmer AK, Werner FW, Fortino MD. Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am. 1995;20(4):597–601.

    Article  CAS  PubMed  Google Scholar 

  36. Waitayawinyu T, McCallister WV, Nemechek NM, Trumble TE. Scaphoid nonunion. J Am Acad Orthop Surg. 2007;15(5):308–20.

    Google Scholar 

  37. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am. 1981;6(2):153–62.

    Article  CAS  PubMed  Google Scholar 

  38. Gofton WT, Gordon KD, Dunning CE, Johnson JA, King GJ. Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study. J Hand Surg Am. 2004;29(3):423–31.

    Article  PubMed  Google Scholar 

  39. Adams BD, Lawler E. Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg. 2007;15(9):571–5.

    Article  PubMed  Google Scholar 

  40. Ward LD, Ambrose CG, Masson MV, Levaro F. The role of the distal radioulnar ligaments, interosseus membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg Am. 2000;25(2):341–51.

    Article  CAS  PubMed  Google Scholar 

  41. Adams BD, Holley KA. Strains in the articular disk of the triangular fibrocartilage complex: a biomechanical study. J Hand Surg Am. 1993;18(5):919–25.

    Article  CAS  PubMed  Google Scholar 

  42. Schuind F, An KN, Berglund L, Rey R, Cooney WP III, Linscheid RL, Chao EY. The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am. 1991;16(6):1106–14.

    Article  CAS  PubMed  Google Scholar 

  43. Ekenstam FAF, Hagert CG. Anatomical studies of the geometry and stability of the distal radioulnar joint. Scand J Plast Reconstr Surg. 1985;19(1):17–25.

    Google Scholar 

  44. Chidgey LK, Dell PC, Bittar ES, Spanier SS. Histologic anatomy of the triangular fibrocartilage. J Hand Surg Am. 1991;16(6):1084–100.

    Article  CAS  PubMed  Google Scholar 

  45. Zimmerman RM, Kim JM, Jupiter JB. Arthritis of the distal radioulnar joint: from Darrach to total joint arthroplasty. J Am Acad Orthop Surg. 2012;20(10):623–32.

    PubMed  Google Scholar 

  46. Epner RA, Bowers WH, Guilford WB. Ulnar variance—the effect of wrist positioning and roentgen filming technique. J Hand Surg Am. 1982;7(3):298–305.

    Article  CAS  PubMed  Google Scholar 

  47. Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am. 1993;18(4):713–6.

    Article  CAS  PubMed  Google Scholar 

  48. Tomaino MM. The importance of the pronated grip X-ray view in evaluating ulnar variance. J Hand Surg Am. 2000;25(2):352–7.

    Article  CAS  PubMed  Google Scholar 

  49. Mino DE, Palmer AK, Levinsohn EM. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint: a prospective study. J Bone Joint Surg Am. 1985;67(2):247–52.

    Article  CAS  PubMed  Google Scholar 

  50. Scheker LR, Belliappa PP, Acosta R, German DS. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg Br. 1994;19(3):310–8.

    Article  CAS  PubMed  Google Scholar 

  51. Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ. The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am. 2001;26(2):236–43.

    Article  CAS  PubMed  Google Scholar 

  52. Wechsler RJ, Wehbe MA, Rifkin MD, Edeiken J, Branch HM. Computed tomography diagnosis of radioulnar subluxation. Skeletal Radiol. 1987;16(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  53. Amrami KK, Moran SL, Berger RA, Ehman EC, Felmlee JP. Imaging the distal radioulnar joint. Hand Clin. 2010;26(4):467–75.

    Article  PubMed  Google Scholar 

  54. Millard GM, Budoff JE, Paravic V, Noble PC. Functional bracing for distal radioulnar joint instability. J Hand Surg. 2002;27(6):972–7.

    Article  Google Scholar 

  55. Frykman G. Fracture of the distal radius including sequelae—shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand. 1967:Suppl 108:3+.

    Google Scholar 

  56. Geissler WB, Fernandez DL, Lamey DM. Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res. 1996;327:135–46.

    Article  Google Scholar 

  57. Hauck RM, Skahen J III, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am. 1996;21(3):418–22.

    Article  CAS  PubMed  Google Scholar 

  58. Peterson MS, Adams BD. Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg. 1993;18(2):328–34.

    Article  Google Scholar 

  59. Hui FC, Linscheid RL. Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am. 1982;7(3):230–6.

    Article  CAS  PubMed  Google Scholar 

  60. Boyes JH. Surgical repair of joints. In: Bunnell S, editor. Bunnell’s surgery of the hand. Philadelphia: Lippincott; 1970. p. 294–313.

    Google Scholar 

  61. Johnston Jones K, Sanders WE. Posttraumatic radioulnar instability: treatment by anatomic reconstruction of volar and radioulnar ligaments. Orthop Trans. 1995–1996;19:832.

    Google Scholar 

  62. Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am. 1995;20(6):930–6.

    Article  CAS  PubMed  Google Scholar 

  63. Wallwork NA, Bain GI. Sigmoid notch osteoplasty for chronic volar instability of the distal radioulnar joint: a case report. J Hand Surg Am. 2001;26(3):454–9.

    Article  CAS  PubMed  Google Scholar 

  64. Tham SK, Bain GI. Sigmoid notch osseous reconstruction. Tech Hand Up Extrem Surg. 2007;11(1):93–7.

    Article  PubMed  Google Scholar 

  65. Geissler WB, Slade JF. Fractures of the carpal bones. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2010. p. 639–707.

    Google Scholar 

  66. Wolf JM, Dawson L, Mountcastle SB, Owens BD. The incidence of scaphoid fracture in a military population. Injury. 2009;40(12):1316–9.

    Article  PubMed  Google Scholar 

  67. Doornberg JN, Buijze GA, Ham SJ, Ring D, Bhandari M, Poolman RW. Nonoperative treatment for acute scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Trauma. 2011;71(4):1073–81.

    Article  PubMed  Google Scholar 

  68. Singh HP, Taub N, Dias JJ. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies. Injury. 2012;43(6):933–9.

    Article  CAS  PubMed  Google Scholar 

  69. Yin ZG, Zhang JB, Kan SL, Wang P. Treatment of acute scaphoid fractures: systematic review and meta-analysis. Clin Orthop Relat Res. 2007;460:142–51.

    PubMed  Google Scholar 

  70. Symes TH, Stothard J. A systematic review of the treatment of acute fractures of the scaphoid. J Hand Surg Eur. 2011;36(9):802–10.

    Article  CAS  Google Scholar 

  71. Suh N, Benson EC, Faber KJ, Macdermid J, Grewal R. Treatment of acute scaphoid fractures: a systematic review and meta-analysis. Hand (N Y). 2010;5(4):345–53.

    Article  Google Scholar 

  72. Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: Pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. 2011;36(11):1759–68, e1.

    Google Scholar 

  73. Heinzelmann AD, Archer G, Bindra RR. Anthropometry of the human scaphoid. J Hand Surg Am. 2007;32(7):1005–8.

    Article  PubMed  Google Scholar 

  74. Pichler W, Windisch G, Schaffler G, Heidari N, Dorr K, Grechenig W. Computer-assisted 3-dimensional anthropometry of the scaphoid. Orthopedics. 2010;33(2):85–8.

    Article  PubMed  Google Scholar 

  75. Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am. 1980;5(5):508–13.

    Article  CAS  PubMed  Google Scholar 

  76. Weber ER, Chao EY. An experimental approach to the mechanism of scaphoid waist fractures. J Hand Surg Am. 1978;3(2):142–8.

    Article  CAS  PubMed  Google Scholar 

  77. Horii E, Nakamura R, Watanabe K, Tsunoda K. Scaphoid fracture as a “puncher’s fracture”. J Orthop Trauma. 1994;8(2):107–10.

    Article  CAS  PubMed  Google Scholar 

  78. Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am. 1984;66(4):504–9.

    Article  CAS  PubMed  Google Scholar 

  79. Little CP, Burston BJ, Hopkinson-Woolley J, Burge P. Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg Br. 2006;31(3):252–5.

    Article  CAS  PubMed  Google Scholar 

  80. Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma. 2001;51(4):693–702; discussion 702-3.

    Google Scholar 

  81. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid: treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am. 1996;78(12):1829–37.

    Article  CAS  PubMed  Google Scholar 

  82. Jupiter JB, Shin AY, Trumble TE, Fernandez DL. Traumatic and reconstructive problems of the scaphoid. Instr Course Lect. 2001;50:105–22.

    CAS  PubMed  Google Scholar 

  83. Trumble TE, Salas P, Barthel T, Robert KQ III. Management of scaphoid nonunions. J Am Acad Orthop Surg. 2003;11(6):380–91.

    Article  PubMed  Google Scholar 

  84. Buijze GA, Wijffels MM, Guitton TG, Grewal R, van Dijk CN, Ring D; Science of Variation Group. Interobserver reliability of computed tomography to diagnose scaphoid waist fracture union. J Hand Surg Am. 2012;37(2):250–4.

    Google Scholar 

  85. Moon ES, Dy CJ, Derman P, Vance MC, Carlson MG. Management of nonunion following surgical management of scaphoid fractures: current concepts. J Am Acad Orthop Surg. 2013;21(9):548–57.

    PubMed  Google Scholar 

  86. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP III, Linscheid RL. Scaphoid malunion. J Hand Surg Am. 1989;14(4):679–87.

    Article  CAS  PubMed  Google Scholar 

  87. Bain GI, Bennett JD, Richards RS, Slethaug GP, Roth JH. Longitudinal computed tomography of the scaphoid: a new technique. Skeletal Radiol. 1995;24(4):271–3.

    Article  CAS  PubMed  Google Scholar 

  88. Bain GI, Bennett JD, MacDermid JC, Slethaug GP, Richards RS, Roth JH. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998;23(1):76–81.

    Article  CAS  PubMed  Google Scholar 

  89. Smith ML, Bain GI, Chabrel N, Turner P, Carter C, Field J. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am. 2009;34(6):1037–43.

    Article  PubMed  Google Scholar 

  90. Morgan WJ, Breen TF, Coumas JM, Schulz LA. Role of magnetic resonance imaging in assessing factors affecting healing in scaphoid nonunions. Clin Orthop Relat Res. 1997;336:240–6.

    Article  Google Scholar 

  91. Perlik PC, Guilford WB. Magnetic resonance imaging to assess vascularity of scaphoid nonunions. J Hand Surg Am. 1991;16(3):479–84.

    Article  CAS  PubMed  Google Scholar 

  92. Sakuma M, Nakamura R, Imaeda T. Analysis of proximal fragment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging. J Hand Surg Br. 1995;20(2):201–5.

    Article  CAS  PubMed  Google Scholar 

  93. Trumble TE. Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg Am. 1990;15(4):557–64.

    Article  CAS  PubMed  Google Scholar 

  94. Roolker W, Ritt MJ, Bos KE. Spontaneous healing of a non-union of the scaphoid. J Hand Surg Br. 1998;23(1):86–7.

    Article  CAS  PubMed  Google Scholar 

  95. Adams BD, Frykman GK, Taleisnik J. Treatment of scaphoid nonunion with casting and pulsed electromagnetic fields: a study continuation. J Hand Surg Am. 1992;17(5):910–4.

    Article  CAS  PubMed  Google Scholar 

  96. Rettig AC, Weidenbener EJ, Gloyeske R. Alternative management of midthird scaphoid fractures in the athlete. Am J Sports Med. 1994;22(5):711–4.

    Article  CAS  PubMed  Google Scholar 

  97. Davis EN, Chung KC, Kotsis SV, Lau FH, Vijan S. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg. 2006;117(4):1223–35.

    Article  CAS  PubMed  Google Scholar 

  98. Bunker TD, McNamee PB, Scott TD. The Herbert screw for scaphoid fractures: a multicentre study. J Bone Joint Surg Br. 1987;69(4):631–4.

    Article  CAS  PubMed  Google Scholar 

  99. Hunter JC, Escobedo EM, Wilson AJ, Hanel DP, Zink-Brody GC, Mann FA. MR imaging of clinically suspected scaphoid fractures. AJR Am J Roentgenol. 1997;168(5):1287–93.

    Article  CAS  PubMed  Google Scholar 

  100. Kuhlmann JN, Mimoun M, Boabighi A, Baux S. Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid. J Hand Surg Br. 1987;12(2):203–10.

    Article  CAS  PubMed  Google Scholar 

  101. Sheetz KK, Bishop AT, Berger RA. The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts. J Hand Surg Am. 1995;20(6):902–14.

    Article  CAS  PubMed  Google Scholar 

  102. Stark A, Brostrom LA, Svartengren G. Surgical treatment of scaphoid non-union: review of the literature and recommendations for treatment. Arch Orthop Trauma Surg. 1989;108(4):203–9.

    Article  CAS  PubMed  Google Scholar 

  103. Korkala OL, Kuokkanen HO, Eerola MS. Compression-staple fixation for fractures, non-unions, and delayed unions of the carpal scaphoid. J Bone Joint Surg Am. 1992;74(3):423–6.

    Article  CAS  PubMed  Google Scholar 

  104. Huene DR, Huene DS. Treatment of nonunions of the scaphoid with the Ender compression blade plate system. J Hand Surg Am. 1991;16(5):913–22.

    Article  CAS  PubMed  Google Scholar 

  105. Leixnering M, Pezzei C, Weninger P, Mayer M, Bogner R, Lederer S, et al. First experiences with a new adjustable plate for osteosynthesis of scaphoid nonunions. J Trauma. 2011;71(4):933–8.

    Article  CAS  PubMed  Google Scholar 

  106. Reigstad O, Thorkildsen R, Grimsgaard C, Reigstad A, Røkkum M. Is revision bone grafting worthwhile after failed surgery for scaphoid nonunion? Minimum 8 year follow-up of 18 patients. J Hand Surg Eur. 2009;34(6):772–7.

    Article  CAS  Google Scholar 

  107. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66(1):114–23.

    CAS  PubMed  Google Scholar 

  108. Faucher GK, Golden ML III, Sweeney KR, Hutton WC, Jarrett CD. Comparison of screw trajectory on stability of oblique scaphoid fractures: a mechanical study. J Hand Surg Am. 2014;39(3):430–5.

    Article  PubMed  Google Scholar 

  109. McCallister WV, Knight J, Kaliappan R, Trumble T. Central placement of the screw in simulated fractures of the scaphoid waist. J Bone Joint Surg Am. 2003;85(1):72–8.

    Article  PubMed  Google Scholar 

  110. Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV. Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am. 2000;82(5):633–41.

    Article  CAS  PubMed  Google Scholar 

  111. Shah J, Jones WA. Factors affecting the outcome in 50 cases of scaphoid nonunion treated with Herbert screw fixation. J Hand Surg Br. 1998;23(5):680–5.

    Article  CAS  PubMed  Google Scholar 

  112. Slade JF III, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2003;85-A(Suppl 4):20–32.

    Google Scholar 

  113. Ikeda K, Osamura N, Tomita K. Percutaneous screw fixation without bone graft for cystic-type scaphoid fractures. J Trauma. 2008;65(6):1453–8.

    Article  PubMed  Google Scholar 

  114. Slade JF III, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg. 2008;97(4):280–9.

    Article  PubMed  Google Scholar 

  115. Russe O. Fractures of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-A:759–68.

    Google Scholar 

  116. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am. 1985;10(5):597–605.

    Article  CAS  PubMed  Google Scholar 

  117. Dacho A, Germann G, Sauerbier M. The reconstruction of scaphoid pseudoarthroses with the operation of Matti-Russe. A retrospective follow-up analysis of 84 patients. Unfallchirurg. 2004;107(5):388–96 (article in German).

    Google Scholar 

  118. Barton NJ. Experience with scaphoid grafting. J Hand Surg Br. 1997;22(2):153–60.

    Article  CAS  PubMed  Google Scholar 

  119. Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg. 1995;35(1):54–9.

    Article  CAS  PubMed  Google Scholar 

  120. Inoue G, Shionoya K, Kuwahata Y. Ununited proximal pole scaphoid fractures. Treatment with a Herbert screw in 16 cases followed for 0.5-8 years. Acta Orthop Scand. 1997;68(2):124–7.

    Article  CAS  PubMed  Google Scholar 

  121. Garcia RM, Leversedge FJ, Aldridge JM, Richard MJ, Ruch DS. Scaphoid nonunions treated with 2 headless compression screws and bone grafting. J Hand Surg Am. 2014;39(7):1301–7.

    Article  PubMed  Google Scholar 

  122. Manske PR, McCarthy JA, Strecker WB. Use of the Herbert bone screw for scaphoid nonunions. Orthopedics. 1988;11(12):1653–61.

    CAS  PubMed  Google Scholar 

  123. Fernandez DL. Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions. J Hand Surg Am. 1990;15(1):140–7.

    Article  CAS  PubMed  Google Scholar 

  124. Eggli S, Fernandez DL, Beck T. Unstable scaphoid fracture nonunion: a medium-term study of anterior wedge grafting procedures. J Hand Surg Br. 2002;27(1):36–41.

    Article  CAS  PubMed  Google Scholar 

  125. Inoue G, Shionoya K. Herbert screw fixation by limited access for acute fractures of the scaphoid. J Bone Joint Surg Br. 1997;79(3):418–21.

    Article  CAS  PubMed  Google Scholar 

  126. Robbins RR, Ridge O, Carter PR. Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles. J Hand Surg Am. 1995;20(5):818–31.

    Article  CAS  PubMed  Google Scholar 

  127. Sunagawa T, Bishop AT, Muramatsu K. Role of conventional and vascularized bone grafts in scaphoid nonunion with avascular necrosis: a canine experimental study. J Hand Surg Am. 2000;25(5):849–59.

    Article  CAS  PubMed  Google Scholar 

  128. Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am. 1991;16(3):474–8.

    Article  CAS  PubMed  Google Scholar 

  129. Chang MA, Bishop AT, Moran SL, Shin AY. The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am. 2006;31(3):387–96.

    Article  PubMed  Google Scholar 

  130. Straw RG, Davis TR, Dias JJ. Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery. J Hand Surg Br. 2002;27(5):413.

    Article  CAS  PubMed  Google Scholar 

  131. Gras M, Mathoulin C. Vascularized bone graft pedicled on the volar carpal artery from the volar distal radius as primary procedure for scaphoid non-union. Orthop Traumatol Surg Res. 2011;97(8):800–6.

    Article  CAS  PubMed  Google Scholar 

  132. Mathoulin C, Brunelli F. Further experience with the index metacarpal vascularized bone graft. J Hand Surg Br. 1998;23(3):311–7.

    Article  CAS  PubMed  Google Scholar 

  133. Sawaizumi T, Nanno M, Nanbu A, Ito H. Vascularised bone graft from the base of the second metacarpal for refractory nonunion of the scaphoid. J Bone Joint Surg Br. 2004;86(7):1007–12.

    Article  CAS  PubMed  Google Scholar 

  134. Guimberteau JC, Panconi B. Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery. J Bone Joint Surg Am. 1990;72(1):88–97.

    Article  CAS  PubMed  Google Scholar 

  135. Jones DB Jr, Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010;125(4):1176–84.

    Article  CAS  PubMed  Google Scholar 

  136. Arora R, Lutz M, Zimmermann R, Krappinger D, Niederwanger C, Gabl M. Free vascularised iliac bone graft for recalcitrant avascular nonunion of the scaphoid. J Bone Joint Surg Br. 2010;92(2):224–9.

    Article  CAS  PubMed  Google Scholar 

  137. Al-Jabri T, Mannan A, Giannoudis P. The use of the free vascularised bone graft for nonunion of the scaphoid: a systematic review. J Orthop Surg Res. 2014;9:21.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Sandow MJ. Costo-osteochondral grafts in the wrist. Tech Hand Up Extrem Surg. 2001;5(3):165–72.

    Article  CAS  PubMed  Google Scholar 

  139. Veitch S, Blake SM, David H. Proximal scaphoid rib graft arthroplasty. J Bone Joint Surg Br. 2007;89(2):196–201.

    Article  CAS  PubMed  Google Scholar 

  140. Tropet Y, Lepage D, Gallinet D, Obert L, Garbuio P, Vichard P. Articular reconstructions by a costochondral grafting (or osteochondral costal grafting). Bull Acad Natl Med. 2006;190(7):1439–56 (article in French).

    Google Scholar 

  141. Sunagawa T, Bishop AT, Muramatsu K. Role of conventional and vascularized bone grafts in scaphoid nonunion with avascular necrosis: a canine experimental study. J Hand Surg Am. 2000;25(5):849–59.

    Article  CAS  PubMed  Google Scholar 

  142. Fernandez DL, Eggli S. Non-union of the scaphoid: revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting. J Bone Joint Surg Am. 1995;77(6):883–93.

    Article  CAS  PubMed  Google Scholar 

  143. Smith BS, Cooney WP. Revision of failed bone grafting for nonunion of the scaphoid: treatment options and results. Clin Orthop Relat Res. 1996;327:98–109.

    Article  Google Scholar 

  144. Hori Y, Tamai S, Okuda H, Sakamoto H, Takita T, Masuhara K. Blood vessel transplantation to bone. J Hand Surg Am. 1979;4(1):23–33.

    Article  CAS  PubMed  Google Scholar 

  145. Malerich MM, Clifford J, Eaton B, Eaton R, Littler JW. Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion. J Hand Surg Am. 1999;24(6):1196–205.

    Article  CAS  PubMed  Google Scholar 

  146. Ruch DS, Papadonikolakis A. Resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed previous surgical treatment. J Hand Surg Am. 2006;31(4):588–93.

    Article  PubMed  Google Scholar 

  147. Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am. 1995;20(6):965–70.

    Article  CAS  PubMed  Google Scholar 

  148. Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (SNAC) wrists: a systematic review of outcomes. J Hand Surg Eur. 2009;34(2):256–63.

    Article  CAS  Google Scholar 

  149. Skie MC, Gove N, Ciocanel DE, Smith H. Management of non-united four-corner fusions. Hand (N Y). 2007;2(1):34–8.

    Article  Google Scholar 

  150. Chung KC, Watt AJ, Kotsis SV. A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity. Plast Reconstr Surg. 2006;118(2):433–42.

    Article  CAS  PubMed  Google Scholar 

  151. Shindle MK, Burton KJ, Weiland AJ, Domb BG, Wolfe SW. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur. 2007;32(1):50–3.

    Article  CAS  Google Scholar 

  152. Fenton RL. The naviculo-capitate fracture syndrome. J Bone Joint Surg Am. 1956;38-A(3):681–4.

    Google Scholar 

  153. Kim YS, Lee HM, Kim JP. The scaphocapitate fracture syndrome: a case report and literature analysis. Eur J Orthop Surg Traumatol. 2013;23(Suppl 2):S207–12.

    Article  PubMed  Google Scholar 

  154. Hamdi MF. The scaphocapitate fracture syndrome: report of a case and a review of the literature. Musculoskelet Surg. 2012;96(3):223–6.

    Article  CAS  PubMed  Google Scholar 

  155. Vander Grend R, Dell PC, Glowczewskie F, Leslie B, Ruby LK. Intraosseous blood supply of the capitate and its correlation with aseptic necrosis. J Hand Surg Am. 1984;9(5):677–83.

    Article  CAS  PubMed  Google Scholar 

  156. Burke NG, Cosgrave CH, O’Neill BJ, Kelly EP. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures. BMJ Case Rep. 2014 Mar 31;2014. pii: bcr2014204041.

    Google Scholar 

  157. Natera Cisneros L, Lamas Gómez C, Proubasta Renart I, Moya Gómez E. Fenton syndrome. Rev Esp Cir Ortop Traumatol. 2012;56(5):369–73 (article in Spanish).

    Google Scholar 

  158. Schliemann B, Langer M, Kösters C, Raschke MJ, Ochman S. Successful delayed surgical treatment of a scaphocapitate fracture. Arch Orthop Trauma Surg. 2011;131(11):1555–9.

    Article  PubMed  Google Scholar 

  159. Arbter D, Piatek S, Wichlas F, Winckler S. The scaphocapitate fracture syndrome (Fenton). Handchir Mikrochir Plast Chir. 2009;41(3):171–4 (article in German).

    Google Scholar 

  160. Sawant M, Miller J. Scaphocapitate syndrome in an adolescent. J Hand Surg Am. 2000;25(6):1096–9.

    Article  CAS  PubMed  Google Scholar 

  161. Geissler WB. Carpal fractures in athletes. Clin Sports Med. 2001;20(1):167–88.

    Article  CAS  PubMed  Google Scholar 

  162. Failla JM. Osteonecrosis associated with nonunion of the hook of the hamate. Orthopedics. 1993;16(2):217–8.

    CAS  PubMed  Google Scholar 

  163. Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg Am. 1993;18(6):1075–9.

    Article  CAS  PubMed  Google Scholar 

  164. Pajares-López M, Hernández-Cortés P, Robles-Molina MJ. Rupture of small finger flexor tendons secondary to asymptomatic nonunion of the hamate hook. Orthopedics. 2011;34(2):142.

    PubMed  Google Scholar 

  165. Andresen R, Radmer S, Scheufler O, Adam C, Bogusch G. Optimization of conventional X-ray images for the detection of hook of hamate fractures. Rontgenpraxis. 2006;56(2):59–65.

    Article  PubMed  Google Scholar 

  166. Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Invest Radiol. 1999;34(1):46–50.

    Article  CAS  PubMed  Google Scholar 

  167. Carroll RE, Lakin JF. Fracture of the hook of the hamate: acute treatment. J Trauma. 1993;34(6):803–5.

    Article  CAS  PubMed  Google Scholar 

  168. Sakuma Y, Iwamoto T, Momohara S. Ununited fracture of the hook of hamate treated with low-intensity pulsed ultrasound in an older middle-aged patient. Clin J Sport Med. 2014;24(4):358–9.

    Article  PubMed  Google Scholar 

  169. Demirkan F, Calandruccio JH, Diangelo D. Biomechanical evaluation of flexor tendon function after hamate hook excision. J Hand Surg Am. 2003;28(1):138–43.

    Article  PubMed  Google Scholar 

  170. Bachoura A, Wroblewski A, Jacoby SM, Osterman AL, Culp RW. Hook of hamate fractures in competitive baseball players. Hand (N Y). 2013;8(3):302–7.

    Article  Google Scholar 

  171. Green DP. Complications of phalangeal and metacarpal fractures. Hand Clin. 1986;2(2):307–28.

    CAS  PubMed  Google Scholar 

  172. Jupiter JB, Koniuch MP, Smith RJ. The management of delayed union and nonunion of the metacarpals and phalanges. J Hand Surg. 1985;10(4):457–66.

    Article  CAS  Google Scholar 

  173. Ring D. Malunion and nonunion of the metacarpals and phalanges. J Bone Joint Surg Am. 2005;87:1380–8.

    Google Scholar 

  174. Smith FL, Rider DL. A study of the healing of one hundred consecutive phalangeal fractures. J Bone Joint Surg. 1935;17:91–109.

    Google Scholar 

  175. Weckesser EC. Rotational osteotomy of the metacarpal for overlapping fingers. J Bone Joint Surg. 1965;47(4):751–6.

    Article  CAS  PubMed  Google Scholar 

  176. Creighton JJ, Steichen JB. Complications in phalangeal and metacarpal fracture management. Results of extensor tenolysis. Hand Clin. 1994;10(1):111–6.

    PubMed  Google Scholar 

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Lyons, M., Fashandi, A., Freilich, A.M. (2018). Nonunions of the Wrist and Hand. In: Agarwal, A. (eds) Nonunions. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-7178-7_7

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