Pdf scaphoid fracture non union treated by bone graft and. Thus when fracture of the scaphoid is suspected, further evaluation should be initiated with care, and if. Scaphoid fractures that do not heal are referred to as a scaphoid non union. Type c fractures are delayed unions, and type d fractures are established nonunions. This type of fracture occurs most often after a fall onto an outstretched hand. In non union, the bony fragments are still completely separated. The treatment of scaphoid nonunion and malunions has undergone a considerable transition since the 1960 modification of mattis technique by russe. Macklichtman type iv or v scaphoid nonunions have midcarpal arthritis, with. Non union of scaphoid fracture in a cricketer possibility. Diagnosis and management of scaphoid fractures american.
The initial injury was from a fall onto his outstretched hand. Scaphoid fractures and nonunions, in trumble te ed. Due to poor vascular supply of the proximal scaphoid, nonunion and delayed union of scaphoid fractures are common. 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. 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. Hybrid russe procedure for scaphoid waist fracture nonunion.
The following symptoms are not meant to diagnose a condition. Prediction of outcome of nonoperative treatment of acute. It is located just below the thumb and is one of the most commonly fractured broken bones in the wrist. So, this is the main reason why a scaphoid fracture needs to be recognised and treated promptly. Missing a scaphoid stress fracture could lead to non union of the scaphoid and early degenerative arthritis of the radiocarpal joint.
Epidemiology scaphoid fractures account for 7080% of all carpal 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. Thirty patients with scaphoid nonunions treated with percutaneous screw fixation. Scaphoid fractures that do not heal are referred to as a scaphoid nonunion. Ultimately, scaphoid non unions can lead to loss of wrist motion and eventual wrist. Searches of the central, medline, embase, cinahl and am. 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. If a scaphoid fracture does not heal, it is called a scaphoid fracture non union. Scaphoid nonunion affects wrist joint function and is often associated with. Scaphoid fracture nonunion orthopaedic surgery michigan. Jun 29, 2007 scaphoid stress fractures are rare and can be a cause of wrist pain in sportspersons. A 30yearold man presented with a symptomatic 15yearold right scaphoid fracture with secondary scaphoid non union advanced collapse of his right wrist. Management of a 15yearold scaphoid nonunion bmj case.
A scaphoid nonunion fracture refers to a wrist fracture that is failing to heal. Treatment of scaphoid waist nonunion with a modified matti. Post traumatic wrist arthritis orthopaedic surgery. These examinations will look for signs of osteonecrosis of the proximal pole. Management of a 15yearold scaphoid nonunion bmj case reports. If a scaphoid fracture goes unrecognized, it often will not heal. Fractures of the scaphoid bone are the most common fractures of the carpus and second in occurrence among fractures of the. If left untreated, the fractured scaphoid bone can sometimes remain unhealed, painful, and symptomatic. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. In the setting of nonunion or an avascular proximal pole, vascularized bone. Current management of scaphoid nonunion based on the. Scaphoid fracture is a break in the scaphoid bone, one of the small bones in your wrist.
Pdf nonunion of fractures of the scaphoid tuberosity. Review of the current methods in the diagnosis and treatment. A scaphoid fracture is a break in one of the small bones of the wrist. Breaks are often caused during falls or as a result of repeated use of the wrist in sports such as skiing. Delayed and non union may be more likely if treatment of a scaphoid fracture is delayed for some reason. Over time, the abnormal motion and collapse of the bone fragments may lead to malalignment within the wrist and subsequent arthritis. In some scaphoid fracture cases, symptoms of a fractured wrist may be mild.
Although some patients with a scaphoid non union have few symptoms, most experience some discomfort and stiffness. When missed, nonunion of scaphoid gradually progresses to arthritic change in the wrist. A lthough the majority of scaphoid fractures heal with nonsurgical treatment, most case series report an approximate 10% nonunion rate. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. An individual may choose not to seek medical treatment. Conventional bone grafting and herbert screw fixation give satisfactory. An unhealed chronic scaphoid fracture is referred to as a scaphoid non union. Hybrid russe procedure for scaphoid waist fracture. Patients often present with an established scaphoid nonunion and a history of a remote spraintype injury years before. Hybrid russe procedure for scaphoid waist fracture nonunion with deformity steve k. 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.
Pdf fracture of scaphoid is relatively common, and accurate and prompt diagnosis leads to bony union with good clinical outcome. T1weighted mr images were evaluated by two musculoskeletal radiologists. Diagnosis patients with a scaphoid non union usually present with a history of previous wrist injury, especially a fall onto an outstretched wrist. When the scaphoid bone is broken, it may not heal properly because it has a very fragile blood supply. Methods a hybrid russe procedure was performed for scaphoid waist fracture nonunions with humpback deformity and no evidence of avascular necrosis. Scaphoid nonunion is a common but difficult problem for hand surgeons. 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. Introduction occur due to fall on outstretched arm or forced dorsiflexion injury to the wrist. Osteonecrosis of the proximal polecanoccurwithascaphoidwaist nonunion, but there is almost always loss of blood supply in proximal pole scaphoid nonunion. This can cause chronic wrist pain and can reduce the career span of a sportsperson. 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.
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. Management of scaphoid nonunion journal of hand surgery. 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. The scaphoid bone is vulnerable to fracture because of its position within the wrist and its role in wrist function. Among all wrist injuries, the incidence of fractures of the scaphoid is. Scaphoid is most frequently fractured carpal bone, often occurring after a fall onto an outstretched hand. Scaphoid fracture in the elite athlete hand surgery, pc. Avascular necrosis occurs in estimated 50% of fractures. Sometimes, even with treatment, it may not heal because of poor blood supply. Non union involving the scaphoid waist often has significant bone loss and. Delayed diagnosis, inadequate initial management, proximal fracture location, osteonecrosis,andassociatedcarpalinstability with acute scaphoid fracture can lead to nonunion of the scaphoid.
Scaphoid non union affects wrist joint function and is often associated with a predictable pattern of degenerative change. Scaphoid fracture and nonunion linkedin slideshare. The aim of the treatment of the non united scaphoid therefore is to heal the bone and restore its shape. Fortyfive patients of scaphoid nonunion were treated by cancellous bone grafting. Arthroscopic surgery of scaphoid nonunion arthroscopy of. Ultimately, scaphoid non unions can lead to loss of wrist motion and eventual wrist arthritis. The scaphoid is one of the eight small bones in the wrist.
Scaphoid is most commonly fractured carpal bone that ac. Mack lichtman type iv or v scaphoid nonunions have midcarpal arthritis, with. A fracture that is healing more slowly than expected is a delayed union fracture. Aug 28, 2017 the cause, symptoms, diagnosis and treatment options for scaphoid fracture non union explained in 3 minutes. Mar 14, 2018 the fracture line in type b1 obliquely runs from the midthird of the volar aspect to the proximal third of the dorsal aspect, type b2 fracture is a transverse complete scaphoid waist fracture, type b3 fracture is a proximal pole fracture, and type b4 fracture is a transscaphoid perilunate fracture dislocation. Pdf fracture of the tuberosity of the scaphoid is common and usually heals without incident because of the good blood supply. Taking a ct arthrogram or an mri of the wrist is essential to diagnose scaphoid nonunion accurately. Magnetic resonance imaging or bone scintigraphy may be useful if the diagnosis remains unclear after. 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. If untreated, the natural history is the development of wrist osteoarthritis causing increasing symptoms and disability. Treatment of scaphoid fractures and nonunions ncbi.
A volar distal radius autologous bone graft was harvested and astrut of cortical bone was fashioned and. The nonunion of the scaphoid was classified according to alnot classification 19. These small bones are arranged into two rows figure 1. The scaphoid sometimes called the navicular is the most important bone in the wrist. 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. Non union if the scaphoid has not healed within 3 months, it is called a non union. All the cases reported in the literature have been sportspersons.
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