Scaphoid nonunion: treatment by open reduction, bone graft, and staple fixation.

Thirty-eight scaphoid nonunions were treated by iliac crest bone grafting and staple fixation. A distractor was inserted through an anterior incision and the scaphoid was distracted to restore its original length. The nonunion was then grafted and held with a staple. Consolidation was achieved in 36 cases despite 6 cases of partial avascular necrosis. Pain at the graft site, which was usually transient, was the only complication. Wrist extension was significantly improved. The main indication for this procedure is pseudarthrosis of the middle third of the scaphoid.