An Evaluation of Excision in the Treatment of Ununited Fracture of the Carpal Scaphoid (Navicular) Bone

Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Compression Screw

“…It was important, at the radiographic evaluation, an angle measurement: if the radio-lunate angle is greater than 30° and the radius scapholunate is greater than 60° 10 it was necessary to employ the Fisk-Fernandez technique to correct DISI 5 using a wedge graft bone from the iliac crest. For advanced degrees of SNAC or necrosis of the proximal pole other techniques may be indicated, such as rescue techniques, including the four corners arthrodesis, 4 resection of the first carpal row, radiocarpal arthrodesis, 17 pure scaphoid excision 18 or the pyrocarbon prosthesis, 4 , 17 , 19 considering the proper indication in each case.…”

Four-corner arthrodesis

“…weakness, pain, and loss of function of the wrist. 7,[13][14][15] As such, scaphoidectomy was generally not recommended for the treatment of scaphoid nonunions. 7 However, when the scaphoid fragments were arthrodesed to the capitate, pain diminished and strength improved.…”

Bone-Grafting Techniques for Scaphoid Nonunion

“…Early treatment of the scaphoid nonunion included radial styloid excision (7), resection of the proximal pole (1O, 23), and bone grafting. For fractures in which there was a delay in achieving union (delayed union), bone grafting (1 2,29) was recommended as early as the 1940s.…”

“…Other early treatment methods included fusion of the distal and proximal parts of the scaphoid to the 0 s magnum [capitate (82)] or excision of the proximal part (23) with fusion if the proximal part was small. Bentzon and Madsen (10) recommended interposition of soft tissues across the fracture line, with variable results.…”