Scaphoid Nonunions.

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Abstract

[Indexed for MEDLINE] 3. Orthop Clin North Am. 2020 Jan;51(1):65-76. doi: 10.1016/j.ocl.2019.08.010. Epub 2019 Oct 17. Scaphoid Reconstruction. Borges CS(1), Ruschel PH(2), Pignataro MB(2). Author information: (1)Division of the Orthopedics and Traumatology Department, Santa Casa Hospital Complex, Porto Alegre, Brazil; Clinica da Mao ao Cotovelo, 569/601 Soledade Street, Porto Alegre, Rio Grande do Sul 90470-340, Brazil. Electronic address: steinborges5@gmail.com. (2)Division of the Orthopedics and Traumatology Department, Santa Casa Hospital Complex, Porto Alegre, Brazil; Clinica da Mao ao Cotovelo, 569/601 Soledade Street, Porto Alegre, Rio Grande do Sul 90470-340, Brazil. Surgical strategies for scaphoid nonunions become more complex based on time from injury to treatment. The decision-making process, however, can follow a logical sequence. Scaphoid nonunions less than 1 year after trauma and no carpal malalignment can be treated with percutaneous screw fixation under fluoroscopic and/or arthroscopic guidance. Reinterventions or patients with avascular proximal poles that do not need substantial grafts are reliably treated with pedicle vascularized bone grafts. Resection of the distal pole of the scaphoid is a good option in old nonunions or after a failed scaphoid procedures. When there are radioscaphoid degenerative changes, salvage procedures such as proximal row carpectomy (PRC) should be considered. Copyright © 2019 Elsevier Inc. All rights reserved. DOI: 10.1016/j.ocl.2019.08.010