1 The importance of a correct diagnosis and appropriate treatment of scaphoid fractures lies in its blood supply. The scaphoid is the most commonly fractured carpal bone, accounting for approximately 60% of all carpal fractures. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions. ![]() Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole, and may show a humpback deformity on the radiograph. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. ![]() Improvements in the diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Scaphoid fractures are common, but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid.
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