The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.
AmramiKKFrickMAMatsumotoJM.Imaging for acute and chronic scaphoid fractures. Hand Clin. 2019,
35: 241–57.
2.
De VitisRPassiatoreMPernaAFioravanti CinciGTaccardoG.Comparison of shape memory staple and gelled platelet-rich plasma versus shape memory staple alone for the treatment of waist scaphoid nonunion: A single-center experience. Joints. 2019,
7: 84–90.
3.
DeanBJFLittleCRileyND, et al.
Suspected scaphoid injuries managed by MRI direct from the emergency department: A single-centre prospective cohort study. Bone Jt Open. 2021,
2: 447–53.
4.
DiasJJBrealeySDFairhurstC, et al.
Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet. 2020,
396: 390–401.
5.
DiPrinzioEVDieterichJDWalshAL, et al.
Two parallel headless compression screws for scaphoid fractures: Radiographic analysis and preliminary outcome. Hand (N Y). Epub ahead of print2022.
6.
DoddsSDWilliamsJBSeiterMChenC.Lessons learned from volar plate fixation of scaphoid fracture nonunions. J Hand Surg Eur Vol. 2018,
43: 57–65.
7.
DuncumbJWRobinsonPGWilliamsonTR, et al.
Bone grafting for scaphoid nonunion surgery: A systematic review and meta-analysis. Bone Joint J. 2022,
104-B: 549–58.
8.
DunnJKusnezovNFaresAMitchellJPirela-CruzM.The scaphoid staple: A systematic review. Hand (N Y). 2017,
12: 236–41.
9.
FergusonDOShanbhagVHedleyH, et al.
Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft. J Hand Surg Eur Vol.2016,
41: 492–500.
10.
GarciaRMLeversedgeFJAldridgeJMRichardMJRuchDS.Scaphoid nonunions treated with 2 headless compression screws and bone grafting. J Hand Surg Am. 2014,
39: 1301–7.
11.
GireJDThioTBehnAWKamalRNLaddAL.Rotational stability of scaphoid waist nonunion bone graft and fixation techniques. J Hand Surg Am. 2020,
45: 841–9.e1.
12.
GoyalTSankineaniSRTripathySK.Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: A comparative study. Musculoskelet Surg. 2013,
97: 109–14.
GrewalRSuhNMacDermidJC.Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union. Open Orthop J. 2016,
10: 431–8.
15.
HigginsJPGiladiAM.Scaphoid nonunion vascularised bone grafting in 2021: Is avascular necrosis the sole determinant?J Hand Surg Am. 2021,
46: 801–6.e2.
16.
LeslieIJDicksonRA.The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg Br. 1981,
63-B: 225–30.
17.
MalleeWHWangJPoolmanRW, et al.
Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev. 2015,
2015: CD010023.
18.
MandalesonAThamSKLewisCAcklandDCEkET.Scaphoid fracture fixation in a nonunion model: A biomechanical study comparing 3 types of fixation. J Hand Surg Am. 2018,
43: 221–8.
19.
MehlingIMArsalan-WernerAWingenbachVSeegmullerJSchlageterMSauerbierM.Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg. 2019,
139: 1161–9.
20.
NicholsonLTSocholKMAzadAAlluriRKHillJRGhiassiA.Single versus dual headless compression screw fixation of scaphoid nonunions: A biomechanical comparison. Hand (N Y). 2022,
17: 1122–7.
21.
QuadlbauerS.BeerT.PezzeiC, et al.
Stabilization of scaphoid type B2 fractures with one or two headless compression screws. Arch Orthop Trauma Surg. 2017,
137: 1587–95.
22.
RadfordPJMatthewsonMHMeggittBF.The Herbert screw for delayed and non-union of scaphoid fractures: A review of fifty cases. J Hand Surg Br. 1990,
15: 455–9.
23.
SabbaghMDMorsyMMoranSL.Diagnosis and management of acute scaphoid fractures. Hand Clin. 2019,
35: 259–69.
24.
SiotosCAsifMLeeJ, et al.
Cast selection and non-union rates for acute scaphoid fractures treated conservatively: A systematic review and meta-analysis. J Plast Surg Hand Surg. 2023,
57: 16–21.
25.
SladeJF3rdGeisslerWBGutowAPMerrellGA.Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2003,
85-ASuppl 4: 20–32.
26.
StoesserHPadmoreCENishiwakiMGammonBLangohrGDGJohnsonJA.Biomechanical evaluation of carpal kinematics during simulated wrist motion. J Wrist Surg. 2017,
6: 113–9.
27.
SuhNGrewalR.Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol. 2018,
43: 4–12.
28.
SurkeCHuntingtonLSZhangXEkETHAcklandDThamSK.Double-screw osteosynthesis in an unstable scaphoid fracture model: A biomechanical comparison of two screw configurations. J Hand Surg Am. 2022,
47: 1118.e1–8.e8.
29.
VanheesMvan RietRRPvan HaverAKebrleRMeermansGVerstrekenF.Percutaneous, transtrapezial fixation without bone graft leads to consolidation in selected cases of delayed union of the scaphoid waist. J Wrist Surg. 2017,
6: 183–7.
30.
WaeckerleJF.A prospective study identifying the sensitivity of radiographic findings and the efficacy of clinical findings in carpal navicular fractures. Ann Emerg Med. 1987,
16: 733–7.
31.
WolfeSWPedersonWCKozinSHCohenMS.Green’s operative hand surgery, 8th edn.
Philadelphia, Elsevier, Inc, 2022: volumes cm.
32.
ZuraRXiongZEinhornT, et al.
Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016,
151: e162775.
