Treatment of selected patients with an ununited fracture of the proximal part of the scaphoid by excision of the fragment and insertion of a carved silicone-rubber spacer.

Abstract

An ununited scaphoid fracture whose proximal fragment is small, sclerotic, fragmented, or badly deformed is usually not suitable for bone-grafting. We treated twenty-one such patients by excision of the small proximal fragment through a volar incision and the insertion of a hand-carved silicone-rubber spacer. After surgery, twenty patients (95 per cent) were able to return to work and engage in strenuous activities, including sports. Pain was significantly relieved, although wrist motions and grip were only minimally improved. Preoperative and postoperative comparative measurements of carpal collapse and translation showed only insignificant changes after this procedure.