Management of nonunion following surgery of scaphoid fracture / 中华创伤骨科杂志

ABSTRACT

Treatment of scaphoid nonunion after failed surgery for acute scaphoid fracture presents a unique challenge.Prior surgery complicates evaluation of the patient and increases the technical difficulty of future procedures.Healing of nonunion is crucial to prevention of carpal collapse and progressive arthritis.It is required to identify whether the technical factors or treatment methods led to the failure of primary surgery.CT is important for confirming nonunion and planning revision surgery.Several studies have described the use of bone grafts and fixation devices for scaphoid nonunion repair,including nonvascularized and vascularized bone grafts,screws,pins,and plates.Satisfactory healing rates have been achieved using nonvascularized bone grafts supplemented with screw or wire fixation,especially in the absence of bone necrosis.Although vascularized grafts require high demanding surgical skills,they improve the odds of union in the setting of osteonecrosis.