Advertisement
Research Article| Volume 4, ISSUE 4, P233-249, November 2004

Scaphoid proximal pole fractures and nonunions

      Fractures and nonunions of the scaphoid are common and can present specific challenges for both diagnosis and treatment. We review the anatomy, cause, presentation, and various treatment options that may be considered by the surgeon, with a concentration on newer techniques.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cooney W.P.
        • Dobyns J.H.
        • Linscheid R.L.
        Nonunion of the scaphoid.
        J Hand Surg. 1980; 5: 343-354
        • Cosio M.Q.
        • Camp R.A.
        Percutaneous pinning of symptomatic scaphoid nonunions.
        J Hand Surg. 1986; 11A: 350-355
        • Desai V.V.
        • Davis T.R.C.
        • Barton N.J.
        The prognostic value and reproducibility of the radiological features of the fractured scaphoid.
        J Hand Surg. 1999; 24B: 586-590
        • Duppe H.
        • Johnell O.
        • Lundborg G.
        • Karlsson M.
        • Redlund-Johnell I.
        Long-term results of fracture of the scaphoid.
        J Bone Joint Surg. 1994; 76A: 249-252
        • Gelberman R.H.
        • Wolock B.S.
        • Siegel D.B.
        Current concepts review.
        J Bone Joint Surg. 1989; 71A: 1560-1565
        • Green D.P.
        The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion.
        J Hand Surg. 1985; 10A: 597-605
        • Mulder J.D.
        The results of 100 cases of pseudoarthrosis in the scaphoid bone treated by the Matti-Russe operation.
        J Bone Joint Surg. 1968; 50B: 110-115
        • Rettig A.C.
        Management of acute scaphoid fractures.
        Hand Clin. 2000; 16: 381-395
        • Russe O.
        Fracture of the carpal navicular.
        J Bone Joint Surg. 1960; 42A: 759-768
        • Stark H.H.
        • Rickard T.A.
        • Zemel N.P.
        • Ashworth C.R.
        Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation.
        J Bone Joint Surg. 1988; 70A: 982-991
        • Stewart M.J.
        Fractures of the carpal navicular (scaphoid).
        J Bone Joint Surg. 1954; 36A: 998-1006
        • DeMaagd R.L.
        • Engber W.D.
        Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions.
        J Hand Surg. 1989; 14A: 996-1003
        • Hill N.A.
        Fractures and dislocations of the carpus.
        Orthop Clin. 1970; 1: 275-284
        • Bynum E.B.
        • Culp R.W.
        • Bonatus T.J.
        • Alexander C.E.
        • McCarroll H.R.
        Repeat Russe bone grafting after failed bone graft surgery for scaphoid non-union.
        J Hand Surg. 1995; 20B: 373-378
        • Shah J.
        • Jones W.A.
        Factors affecting the outcome in 50 cases of scaphoid nonunion treated with Herbert screw fixation.
        J Hand Surg. 1998; 23B: 680-685
        • Prieser G.
        Eine typische posttraumatische und zur spontanfrakture fuhrende ostitis des naviculare carpi.
        Fortschr Geb Rontgenstr. 1910; 15: 189-197
      1. Lexer E, Kuliga, Turk W. Untersuchungen uber knochenarterien mittelst rontgenaufnahmen injizierter knochen und ihre bedeutung fur einzelne pathologische vorgange am knochensysteme. Berlin: August Hirschwald, 1904.

        • Lutzeler H.
        Die entstehungsurache der pseudarthrose nack bruch des kahnbeins der hand.
        Durtsche Zeitschr F Chir. 1932; 235: 450-467
        • Bohler L.
        Technik der knochengruchbehandlung im frieden und im kriege. Verlag Von Hilhelm Maudrich, Wien1943: 122-124
        • Obletz B.E.
        • Halbstein B.M.
        Non-union of fractures of the carpal navicular.
        J Bone Joint Surg. 1938; 20A: 424-428
        • Taleisnik J.
        • Kelly P.J.
        The extraosseous and intraosseous blood supply of the scaphoid bone.
        J Bone Joint Surg. 1966; 48A: 1125-1137
        • Gelberman R.H.
        • Menon J.
        The vascularity of the scaphoid.
        J Hand Surg. 1980; 5: 508-513
        • Botte M.J.
        • Mortensen W.W.
        • Gelberman R.H.
        • Rhoades C.E.
        • Gellman H.
        Internal vascularity of the scaphoid in cadavers after insertion of the Herbert screw.
        J Hand Surg. 1988; 13A: 216-220
        • Kuhlmann J.N.
        • Guerin-Surville H.
        Vascularisation extrinseque et intrinseque du scaphoide et de l’os lunaire.
        Bull Assoc Anat. 1981; 65: 433-446
        • Mestdagn H.
        Vascularisation arterielle du semi-lunaire.
        Ann Chir Main. 1982; 1: 246-248
        • Travaglini F.
        Arterial circulation of the carpal bones.
        Bull Hosp Joint Dis. 1959; 20: 19-26
        • Oberlin C.
        • Salon A.
        • Pigeau I.
        • Sarcy J.J.
        • Guidici P.
        • Treil N.
        Three-dimensional reconstruction of the carpus and its vasculature.
        J Hand Surg. 1992; 17A: 767-772
        • Mack G.R.
        • Bosse M.J.
        • Gelberman R.H.
        • Yu E.
        The natural history of scaphoid non-union.
        J Bone Joint Surg. 1984; 66A: 504-509
        • Ruby L.K.
        • Stinson J.
        • Belsky M.R.
        The natural history of scaphoid non-union.
        J Bone Joint Surg. 1985; 67A: 428-432
        • Inoue G.
        • Shionoya K.
        • Kuwahata Y.
        Ununited proximal pole scaphoid fractures. Treatment with a Herbert screw in 16 cases followed for 0.5–8 years.
        Acta Orthop Scand. 1997; 68: 124-127
        • Lindstrom G.
        • Nystrom A.
        Natural history of scaphoid non-union with special reference to “asymptomatic” cases.
        J Hand Surg. 1992; 17B: 697-700
        • Taleisnik J.
        Fractures of carpal bones.
        in: Green D.P. Operative Hand Surgery. 1st ed. Churchill Livingston, New York1982: 669-702
        • Graziani A.
        L’esame radiologico del carpo.
        Radiol Med. 1940; 27: 382
        • Dickson R.A.
        • Leslie I.J.
        Conservative treatment of the fractured scaphoid.
        in: Razemon J.P. Fisk G.R. The wrist. Churchill Livingstone, Edinburgh1988: 80-87
        • Jorgensen T.M.
        • Andresen J.H.
        • Thommesen P.
        • Hansen H.H.
        Scanning and radiology of the carpal scaphoid bone.
        Acta Orthop Scand. 1979; 50: 663-665
        • Tiel-van Buul M.M.C.
        • Broekhuizen T.H.
        • van Beek E.J.R.
        • Bossuyt P.P.M.
        Choosing a strategy for the diagnostic management of suspected scaphoid fracture.
        J Nucl Med. 1995; 36: 45-48
        • Lepisto J.
        • Mattila K.
        • Niemined S.
        • Sattler B.
        • Kormano M.
        Low field MRI and scaphoid fracture.
        J Hand Surg. 1995; 20B: 539-542
        • Imaeda T.
        • Nakamura R.
        • Miura T.
        • Makino N.
        Magnetic resonance imaging in scaphoid fractures.
        J Hand Surg. 1992; 17B: 20-27
        • Margo M.K.
        • Seely J.A.
        A statistical review of 100 cases of the fracture of the carpal navicular bone.
        Clin Orthop. 1963; 31: 102-105
        • Obrien L.
        • Herbert T.
        Internal fixation of acute scaphoid fractures.
        Aust N Z J Surg. 1985; 55: 387-389
        • Trumble T.E.
        • Vo D.
        Proximal pole scaphoid fractures and nonunion.
        J Am Acad Orthop Surg. 2001; 3: 155-171
        • Linscheid R.L.
        • Weber E.R.
        Scaphoid fractures and nonunion.
        in: Cooney W.B. Linscheid R.L. Dobyns J.H. The wrist diagnosis and operative treatment. Mosby, St. Louis1998: 385-430
        • Trumble T.E.
        • Clarke T.
        • Kreder H.J.
        Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws.
        J Bone Joint Surg. 1996; 78A: 1829-1837
        • Trumble T.E.
        • Gilbert M.
        • Murray L.W.
        • Smith J.
        • Rafijah G.
        • McCallister W.V.
        Displace scaphoid fractures treated with open reduction and internal fixation with a cannulated screw.
        J Bone Joint Surg. 2000; 82A: 633-641
        • Rettig M.E.
        • Raskin K.B.
        Retrograde compression screw fixation of acute proximal pole scaphoid fractures.
        J Hand Surg. 1999; 24A: 1206-1210
        • Buch K.A.
        • Nayak R.K.
        Isolate fracture dislocation of the proximal fragment of the scaphoid.
        Int J Care Injured. 2000; 31: 265-266
        • Perlik P.C.
        • Guilford B.
        Magnetic resonance imaging to assess vascularity of scaphoid nonunions.
        J Hand Surg. 1991; 16A: 479-484
        • Urban M.A.
        • Green D.B.
        • Aufdemorte T.B.
        The patchy configuration of scaphoid avascular necrosis.
        J Hand Surg. 1993; 18A: 669-674
        • Trumble T.E.
        Avascular necrosis after scaphoid fracture.
        J Hand Surg. 1990; 15A: 557-564
        • Morgan W.J.
        • Breen T.F.
        • Coumas J.M.
        • Schulz L.A.
        Role of magnetic resonance imaging in assessing factors affecting healing in scaphoid nonunions.
        Clin Orthop. 1997; 336: 240-246
        • Herbert T.J.
        • Lanzetta M.
        Idiopathic avascular necrosis of the scaphoid.
        J Hand Surg. 1993; 19B: 174-182
        • Buchler U.
        • Nagy L.
        The issue of vascularity in fractures and nonunion of the scaphoid.
        J Hand Surg. 1995; 20B: 726-735
        • Herbert T.J.
        The fractured scaphoid. Quality Medical, St. Louis1990: 121-138
        • Matti H.
        T\echnik und resultate meiner pseudarthosenoperation.
        Z Chir. 1965; 63: 1442-1453
        • Murray G.
        Bone-graft for non-union of the carpal scaphoid.
        Br J Surg. 1934; 22: 63-68
        • Boecksytns M.E.H.
        • Busch P.
        Surgical treatment of scaphoid pseudoarthrosis. Evaluation of the results after soft tissue arthroplasty and inlay bone grafting.
        J Hand Surg. 1984; 9A: 378-382
        • Dooley B.J.
        Inlay bone grafting for non-union of the scaphoid bone by the anterior approach.
        J Bone Joint Surg. 1968; 50B: 102-109
        • McConald G.
        • Petrie D.
        Un-united fracture of the scaphoid.
        Clin Orthop. 1975; 108: 110-114
        • Pennsylvania Orthopedic Society Scientific Research Committee
        Evaluation of treatment for non-union of the carpal navicular.
        J Bone Joint Surg. 1962; 44A: 169-174
        • Rasmussen P.
        • Schwab J.P.
        • Johnson R.P.
        Symptomatic nonunions treated by Russe bone grafting.
        Orthop Rev. 1985; 14: 41-47
        • Schneider L.H.
        • Aulcicno P.
        Nonunion of the carpal scaphoid. The Russe procedure.
        J Trauma. 1982; 22: 315-319
        • Steichen J.B.
        • Schreiber D.R.
        Radial bone graft with prolonged immobilization for scaphoid nonunion.
        Contemp Orthop. 1986; 12: 19-24
        • Torngren S.
        • Sandqvist S.
        Pseudoarthrosis in the scaphoid bone treated by grafting with autogenous bone-peg. A follow-up study.
        Acta Orthop Scand. 1974; 45: 82-88
        • Unger H.S.
        • Sryker W.C.
        Nonunion of the carpal navicular. Analysis of 42 cases by the Russe procedure.
        South Med J. 1969; 62: 620-622
        • Verdan C.
        • Narakas A.
        Fractures and pseudoarthrosis of the scaphoid.
        Surg Clin North Am. 1968; 48: 1083-1095
        • Korkala O.L.
        • Antti-Poika U.
        Late treatment of scaphoid fractures by bone grafting and compression staple osteosynthesis.
        J Hand Surg. 1989; 14A: 491-495
        • Herbert T.J.
        • Fisher W.E.
        Management of the fractured scaphoid using a new bone screw.
        J Bone Joint Surg. 1984; 66B: 114-123
        • Fernandez D.L.
        Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions.
        J Hand Surg. 1990; 15A: 140-147
        • Rajagopalan B.M.
        • Squire D.S.
        • Samuels L.O.
        Results of Herbert-screw fixation with bone-grafting for the treatment of nonunion of the scaphoid.
        J Bone Joint Surg. 1999; 81A: 48-51
        • Robbins R.R.
        • Carter P.R.
        Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles.
        J Hand Surg. 1995; 20A: 818-831
        • Carrozella J.C.
        • Stern P.J.
        • Murdock P.A.
        The fate of failed bone graft surgery for scaphoid nonunions.
        J Hand Surg. 1989; 14A: 800-806
        • Smith B.S.
        • Cooney W.P.
        Revision of failed bone grafting for nonunion of the scaphoid.
        Clin Orthop. 1996; 327: 98-109
        • Adams B.D.
        • Frykman G.K.
        • Taleisnik J.
        Treatment of scaphoid nonunion with casting and pulsed electromagnetic fields.
        J Hand Surg. 1992; 17A: 910-914
        • Frykman G.K.K.
        • Taleisnik J.
        • Peters G.
        • Kaufman R.
        • Helal B.
        • Wood V.E.
        • et al.
        Treatment of nonunited scaphoid fractures by pulsed electromagnetic field and cast.
        J Hand Surg. 1986; 11A: 344-349
        • Hori Y.
        • Tamai S.
        • Okuda H.
        • Sakamoto H.
        • Takita T.
        • Masuhara K.
        Blood vessel transplantation to bone.
        J Hand Surg. 1979; 4: 23-33
        • Zhenman S.
        • Zhiguang X.
        Experimental study and clinical use of the fascioosteal flap.
        Plast Reconstr Surg. 1986; 78: 201-208
        • Sungawa T.
        • Bishop A.T.
        • Muramatsu K.
        Role of conventional and vascularized bone grafts in scaphoid nonunion with avascular necrosis.
        J Hand Surg. 2000; 25A: 849-859
        • Fernandez D.L.
        • Eggli S.
        Non-union of the scaphoid.
        J Bone Joint Surg. 1995; 77A: 883-892
        • Kawanishi K.
        Treatment of scaphoid necrosis with vascular bundle implantation.
        J Jpn Soc Surg Hand. 1991; 8: 670-674
        • Zaidemberg C.
        • Siebert J.W.
        • Angrigiani C.
        A new vascularized bone graft for scaphoid nonunion.
        J Hand Surg. 1991; 16A: 474-478
        • Sheetz K.K.
        • Bishop A.T.
        • Berger R.A.
        The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts.
        J Hand Surg. 1995; 20A: 902-914
        • Hulbut P.T.
        • VanHeest A.E.
        • Lee K.H.
        A cadaveric anatomic study of radial artery pedicle grafts to the scaphoid and lunate.
        J Hand Surg. 1997; 22A: 408-412
        • Boyer M.I.
        • Von Schroeder H.P.
        • Axelrod T.S.
        Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius.
        J Hand Surg. 1998; 23B: 686-690
        • Uerpairojkit C.
        • Leechavengvongs S.
        • Witoonchart K.
        Primary vascularized distal radius bone graft for nonunion of the scaphoid.
        J Hand Surg. 2000; 25B: 266-270
        • Leung P.C.
        • Hung L.K.
        Use of pronator quadratus bone flap in bony reconstruction around the wrist.
        J Hand Surg. 1990; 15A: 637-640
        • Kawai H.
        • Yamamoto K.
        Pronator quadratus pedicled bone graft for old scaphoid fractures.
        J Bone Joint Surg. 1988; 70B: 829-831
        • Kuhlmann J.N.
        • Mimoun M.
        • Boabighi A.
        • Baux S.
        Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid.
        J Hand Surg. 1987; 12B: 203-210
        • Yuceturk A.
        • Isiklar Z.U.
        • Tuncay C.
        • Tandogan R.
        Treatment of scaphoid nonunions with a vascularized bone graft based on the first dorsal metacarpal artery.
        J Hand Surg. 1997; 22B: 425-427
        • Guimberteau J.C.
        • Panconi B.
        Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery.
        J Bone Joint Surg. 1990; 72A: 88-97
        • Gabl M.
        • Reinhart C.
        • Lutz M.
        • et al.
        Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment.
        J Bone Joint Surg Am. 1999; 81: 1414-1428
        • Doi K.
        • Oda T.
        • Soo-Heong T.
        • Nanda V.
        Free vascularized bone graft for nonunion of the scaphoid.
        J Hand Surg. 2000; 25A: 507-519
        • Zemel N.P.
        • Stark H.H.
        • Ashworth C.R.
        • Rickard T.A.
        • Anderson D.R.
        Treatment of selected patients with an ununited fracture of the proximal part of the scaphoid by excision of the fragment and insertion of a carved silicone-rubber spacer.
        J Bone Joint Surg. 1984; 66A: 510-517
        • Jones K.G.
        Replacement of the proximal portion of the scaphoid with spherical implant for post-traumatic carporadial arthritis.
        J Hand Surg. 1985; 10B: 217-226
        • Swanson A.B.
        • de Groot Swanson G.
        • Maupin B.K.
        • Moss S.H.
        • Ganzhorn R.W.
        • Crane M.W.
        • et al.
        Scaphoid implant resection arthroplasty.
        J Arthroplasty. 1986; 1: 47-62
        • Leslie B.M.
        • O’Malley M.
        • Thibodeau A.A.
        A forty-three-year follow-up of a vitallium scaphoid arthroplasty.
        J Hand Surg. 1991; 16A: 465-468
        • Agner O.
        Treatment of non-united navicular fractures by total excision of the bone and the insertion of acrylic prostheses.
        Acta Orthop Scand. 1963; 33: 235-245
        • Carter P.R.
        • Malinin T.I.
        • Abbey P.A.
        • Sommerkamp T.G.
        The scaphoid allograft.
        J Hand Surg. 1989; 14A: 1-12
        • Sandow M.J.
        Proximal scaphoid costo-osteochondral replacement arthroplasty.
        J Hand Surg. 1998; 23B: 201-208
        • Malerich M.M.
        • Clifford J.
        • Eaton B.
        • Eaton R.
        • Littler J.W.
        Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion.
        J Hand Surg. 1999; 24A: 1196-1205
      2. Barnard L, Stubbins SG. Styloidectomy of the radius in the surgical treatment of non-union of the carpal navicular. J Bone Joint Surg 30A:98–102.

        • Bentzon P.G.K.
        • Randlov-Madsen A.
        On fracture of the carpal scaphoid.
        Acta Orthop Scand. 1945; 16: 30-39
        • Eaton R.G.
        • Akelman E.
        • Eaton B.H.
        Fascial implant arthroplasty for treatment of radioscaphoid degenerative disease.
        J Hand Surg. 1989; 14A (766–)
        • Meekison D.M.
        Some remarks on three common fractures 1. Fractures of the carpal scaphoid 2. Fractures of the head of the radius 3. Fractures of the medial malleolus.
        J Bone Joint Surg. 1945; 27: 80-85
        • Soto-Hall R.
        • Haldeman K.O.
        The conservative and operative treatment of fractures of the carpal scaphoid (navicular).
        J Bone Joint Surg. 1941; 23: 841-850
        • Wagner C.J.
        Fractures of the carpal navicular.
        J Bone Joint Surg. 1952; 34A: 774-784
        • Ruch D.S.
        • Chang D.S.
        • Poehling G.G.
        Case report.
        J Arthroscopy. 1998; 14: 747-752
        • Boeckstyns M.E.H.
        • Kjaer L.
        • Busch P.
        • Holst-Nielsen F.
        Soft tissue interposition arthroplasty for scaphoid nonunion.
        J Hand Surg. 1985; 10A: 109-114
        • Tomaino M.M.
        • Miller R.J.
        • Cole I.
        • Burton R.I.
        Scapholunate advanced collapse wrist.
        J Hand Surg. 1994; 19A: 134-142
        • Watson H.K.
        • Weinzweig J.
        • Zeppieri J.
        The natural progression of scaphoid instability.
        Hand Clin. 1997; 13: 39-49
      3. Berger R.A. Weiss A.P.C. Hand surgery. Lippincott, Williams & Wilkins, Philadelphia2004: 383 (395, 433, 439)
        • Gelberman R.H.
        • Panagis J.S.
        • Taleisnik J.
        • et al.
        The arterial anatomy of the human carpus: part I. The extraosseous vascularity.
        J Hand Surg. 1983; 8A: 367-376