Surgical treatment for nonunion of the scaphoid.

Fracture of the scaphoid is the most common injury of the carpal bones. Most scaphoid fractures heal after immobilization. When the fracture does not unite, degenerative arthritic changes and disability may occur. Twenty-four symptomatic nonunions treated surgically were reviewed. Based on presence of union, percent of normal motion, and patients' symptoms, results were rated good in 19 cases and fair in five. Nine of ten patients treated with bone grafting and styloidectomy had union of fractures with good results. All five patients with bone grafting and internal fixation had union. Excision of proximal fragments of more than one third to one half of the scaphoid, and internal fixation alone, had unsatisfactory results. A styloidectomy should excise approximately one half of the radius articulating with the scaphoid. If not enough styloid is excised, osteophytic overgrowth will occur; if too much is excised, the carpus will sublux radially.