Acute scaphoid fractures and non-unions

Abstract

The diagnosis of scaphoid fractures requires a high index of suspicion, with a focus on the mechanism of injury and careful clinical examination. A scaphoid series of radiographs is required but if negative does not rule out a fracture. If there is clinical suspicion for fracture, one should obtain an MRI scan, which has the highest sensitivity and specificity for diagnosis. The management of acute scaphoid fractures is dependent largely on fracture location and displacement, although there are other factors to consider. On the whole, distal pole fractures can be managed conservatively and proximal pole fractures surgically, as the latter have poorer healing potential with a risk of avascular necrosis, due to a retrograde blood supply. The controversy lies with scaphoid waist fractures. One should consider surgical management for displaced waist fractures. The surgical approach is dependent on the fracture location and the surgeon's individual preference. Scaphoid non-union predictably leads to arthritis of the wrist, and therefore should be managed upon diagnosis. Reconstructive surgery provides the best outcomes, and more research is required into conservative treatments. Recent times have seen an increase in the use of vascularized bone grafts. In cases where there is established arthritis, salvage options include scaphoidectomy with four-corner fusion, proximal row carpectomy, total wrist arthroplasty and arthrodesis.