Radial styloidectomy for scaphoid nonunion advanced collapse – relevance of nonunion location

Abstract

Radial styloidectomy along with scaphoid nonunion reconstructive surgery is considered an acceptable surgical treatment for stage 1 scaphoid nonunion advanced collapse. The extent of radioscaphoid joint wear that defines scaphoid nonunion advanced collapse stage 1 is unclear. An appropriate radial styloidectomy is limited to 6 mm styloid removal to prevent carpal instability. The aim of this study was to determine whether nonunion fracture location can be a guiding factor in determining whether the scaphoid bone can be retained with scaphoid nonunion reconstructive surgery and radial styloidectomy. We reviewed wrist radiographs and magnetic resonance imaging studies of 21 patients with a diagnosis of scaphoid nonunion advanced collapse stage 1, and quantified chondral wear as the length of a line (in mm) along the radioscaphoid joint traced from the tip of the radial styloid to the most ulnar position along the radioscaphoid joint. We concluded that scaphoid nonunion reconstructive surgery with radial styloidectomy is only appropriate for nonunions in the distal or middle third of the scaphoid.

Level of evidence: III