When missed, nonunion of scaphoid gradually progresses to arthritic change in the wrist. Treatment of scaphoid waist nonunion with a modified matti. Surgical intervention is often indicated if there are signs that the fracture will not heal with immobilization, the fracture is displaced or the fracture is located in the middle to proximal third of the bone. According to the study by vender for non unions of 4 years duration, 75% of patients had radioscaphoid changes, and for those of 9 years. Feb 26, 2020 the serious consequences of non union, such as progressive degenerative changes and carpal collapse, the socalled snac scaphoid non union advanced collapse wrist have for patients, typically young and active, resulted in a restrictive treatment regime with immobilization from eight to 12 weeks. Scaphoid fracture and nonunion linkedin slideshare. A lthough the majority of scaphoid fractures heal with nonsurgical treatment, most case series report an approximate 10% nonunion rate. Scaphoid fracture nonunion orthopaedic surgery michigan. Mack lichtman type iv or v scaphoid nonunions have midcarpal arthritis, with. Management of a 15yearold scaphoid nonunion bmj case reports. Osteonecrosis of the proximal polecanoccurwithascaphoidwaist nonunion, but there is almost always loss of blood supply in proximal pole scaphoid nonunion.
If a scaphoid fracture goes unrecognized, it often will not heal. In the setting of nonunion or an avascular proximal pole, vascularized bone. Pdf fracture of scaphoid is relatively common, and accurate and prompt diagnosis leads to bony union with good clinical outcome. Searches of the central, medline, embase, cinahl and am. Ultimately, scaphoid non unions can lead to loss of wrist motion and eventual wrist arthritis. Study 3 the above two studies looked at all the parameters that the books suggest cause non union and found that none of figure 1 percentage enhancement parameter that reflects blood flow measurements in proximal and distal fracture fragments of acute scaphoid waist fractures during dynamic. Post traumatic wrist arthritis orthopaedic surgery. Hybrid russe procedure for scaphoid waist fracture nonunion with deformity steve k. The diagnosis of scaphoid nonunion is often delayed, and therefore, treatment must be tailored to the type of fracture, the duration of nonunion, and the presence or absence of resulting arthritis.
Hybrid russe procedure for scaphoid waist fracture. Scaphoid nonunion affects wrist joint function and is often associated with. Type c fractures are delayed unions, and type d fractures are established nonunions. An unhealed chronic scaphoid fracture is referred to as a scaphoid non union.
Among all wrist injuries, the incidence of fractures of the scaphoid is. Patients often present with an established scaphoid nonunion and a history of a remote spraintype injury years before. Management of scaphoid nonunion journal of hand surgery. In some scaphoid fracture cases, symptoms of a fractured wrist may be mild. In addition, lack of recognition of this deformity and undertreatment may result in the. The nonunion of the scaphoid was classified according to alnot classification 19. The following symptoms are not meant to diagnose a condition. Epidemiology scaphoid fractures account for 7080% of all carpal bone.
Introduction occur due to fall on outstretched arm or forced dorsiflexion injury to the wrist. Sometimes, even with treatment, it may not heal because of poor blood supply. A scaphoid fracture is a break in one of the small bones of the wrist. A fracture that is healing more slowly than expected is a delayed union fracture. Scaphoid non union affects wrist joint function and is often associated with a predictable pattern of degenerative change. Scaphoid fracture in the elite athlete hand surgery, pc. The initial injury was from a fall onto his outstretched hand. Although some patients with a scaphoid non union have few symptoms, most experience some discomfort and stiffness. Missing a scaphoid stress fracture could lead to non union of the scaphoid and early degenerative arthritis of the radiocarpal joint.
If a scaphoid fracture does not heal, it is called a scaphoid fracture non union. The scaphoid sometimes called the navicular is the most important bone in the wrist. Thirty patients with scaphoid nonunions treated with percutaneous screw fixation. Fractures of the scaphoid bone are the most common fractures of the carpus and second in occurrence among fractures of the. Scaphoid is most commonly fractured carpal bone that ac. A database search identified 29 patients with chronic scaphoid nonunions who underwent a preoperative mri examination and intraoperative assessment of scaphoid viability from 2004 to 2009. Pdf scaphoid fracture non union treated by bone graft and. Delayed diagnosis, inadequate initial management, proximal fracture location, osteonecrosis,andassociatedcarpalinstability with acute scaphoid fracture can lead to nonunion of the scaphoid. This type of fracture occurs most often after a fall onto an outstretched hand.
If left untreated, the fractured scaphoid bone can sometimes remain unhealed, painful, and symptomatic. Aug 28, 2017 the cause, symptoms, diagnosis and treatment options for scaphoid fracture non union explained in 3 minutes. T1weighted mr images were evaluated by two musculoskeletal radiologists. The aim of the treatment of the non united scaphoid therefore is to heal the bone and restore its shape. Prediction of outcome of nonoperative treatment of acute. The scaphoid is one of the eight small bones in the wrist. Ultimately, scaphoid non unions can lead to loss of wrist motion and eventual wrist. We compared these findings with duration of the non union and with the scaphoid non union advanced collapse classification, which was based on radiographic assessment of the general level of wrist. Scaphoid is most frequently fractured carpal bone, often occurring after a fall onto an outstretched hand.
Avascular necrosis occurs in estimated 50% of fractures. Fortyfive patients of scaphoid nonunion were treated by cancellous bone grafting. Review of the current methods in the diagnosis and treatment. Scaphoid fracture is a break in the scaphoid bone, one of the small bones in your wrist. Non union of scaphoid fracture in a cricketer possibility. Macklichtman type iv or v scaphoid nonunions have midcarpal arthritis, with.
Methods a hybrid russe procedure was performed for scaphoid waist fracture nonunions with humpback deformity and no evidence of avascular necrosis. The scaphoid bone is vulnerable to fracture because of its position within the wrist and its role in wrist function. Non union involving the scaphoid waist often has significant bone loss and. A 30yearold man presented with a symptomatic 15yearold right scaphoid fracture with secondary scaphoid non union advanced collapse of his right wrist.
An individual may choose not to seek medical treatment. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Conventional bone grafting and herbert screw fixation give satisfactory. So, this is the main reason why a scaphoid fracture needs to be recognised and treated promptly. Scaphoid fractures that do not heal are referred to as a scaphoid non union. Taking a ct arthrogram or an mri of the wrist is essential to diagnose scaphoid nonunion accurately. A volar distal radius autologous bone graft was harvested and astrut of cortical bone was fashioned and. Jun 29, 2007 scaphoid stress fractures are rare and can be a cause of wrist pain in sportspersons. In non union, the bony fragments are still completely separated. Diagnosis patients with a scaphoid non union usually present with a history of previous wrist injury, especially a fall onto an outstretched wrist. If a ligament is torn, it may allow a wrist bone to shift out of place, resulting in improper wear and tear of the cartilage. Current management of scaphoid nonunion based on the. When the scaphoid bone is broken, it may not heal properly because it has a very fragile blood supply. Over time, the abnormal motion and collapse of the bone fragments may lead to malalignment within the wrist and subsequent arthritis.
Delayed and non union may be more likely if treatment of a scaphoid fracture is delayed for some reason. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. If untreated, the natural history is the development of wrist osteoarthritis causing increasing symptoms and disability. This pattern occurs when a scaphoid fracture does not heal properly, in which case it is called scaphoid non union advanced collapse snac wrist arthritis. Treatment of scaphoid fractures and nonunions ncbi. These small bones are arranged into two rows figure 1. Scaphoid fractures and nonunions, in trumble te ed.
Arthroscopic surgery of scaphoid nonunion arthroscopy of. Breaks are often caused during falls or as a result of repeated use of the wrist in sports such as skiing. Hybrid russe procedure for scaphoid waist fracture nonunion. This can cause chronic wrist pain and can reduce the career span of a sportsperson. It is located just below the thumb and is one of the most commonly fractured broken bones in the wrist. Scaphoid nonunion is a common but difficult problem for hand surgeons. Thus when fracture of the scaphoid is suspected, further evaluation should be initiated with care, and if. Diagnosis and management of scaphoid fractures american. If neglected or misdiagnosed, non union of a scaphoid fracture will almost inevitably progress to radiographic and symptomatic osteoarthritis of the wrist with subsequent morbidity and lifelong disability, especially in young males in which the fracture is more common. All the cases reported in the literature have been sportspersons. The treatment of scaphoid nonunion and malunions has undergone a considerable transition since the 1960 modification of mattis technique by russe. The pattern of arthritis in scaphoid non union is similar to scapholunate advance collapse slac wrist resulting from rotatory subluxation of the distal scaphoid fragment 15,16. These examinations will look for signs of osteonecrosis of the proximal pole.
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