Management of nonunion following surgical management of scaphoid fractures: current concepts.

Management of scaphoid nonunion after failed surgery for acute scaphoid fracture presents a unique treatment challenge. Prior surgery complicates patient evaluation and increases the technical difficulty of future procedures. Healing of nonunion is crucial to prevent carpal collapse and progressive arthritis. A thorough workup is required to identify technical factors or treatment decisions that may have resulted in a poor outcome after initial fixation attempts. CT is particularly useful for characterizing nonunion and planning revision surgery. Several studies have described the use of bone grafts and fixation devices for scaphoid nonunion repair, including nonvascularized and vascularized bone grafts, screws, pins, and plates. Reliable rates of union have been achieved using nonvascularized bone graft supplemented with screw or wire fixation, particularly in the absence of osteonecrosis. Although vascularized grafts are more technically challenging, they improve the odds of union in the setting of osteonecrosis.