Scaphoid fractures and nonunions.

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. The tenuous vascular anatomy of the scaphoid, the inherent biomechanical instability of scaphoid fractures, and the difficulty of radiographic diagnosis are the culprits of nonunion. The treatment of established scaphoid nonunion is difficult, and more so is the treatment of failed nonunion after grafting. One common method for treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Attention to details of surgical technique are necessary for successful treatment outcome.