Scaphoid Non Union

Problem

  • The scaphoid bone has failed to heal. This causes ongoing pain and eventually leads to wrist arthritis

Cause

  • The scaphoid has a tenuous, retrograde blood supply and is surrounded by synovial fluid. This makes it one of the most common bones to develop a nonunion.

Diagnosis

  • Pain in the ‘snuff box’
  • Weakness of grip strength
  • Decreased wrist movement
  • X-rays usually confirm the diagnosis
  • CT scan to look for a ‘humpback’ deformity
  • MRI scan to assess blood supply to the bone

Treatment

  • Surgery – GA – Day surgery or Overnight Stay

    Incision on back of wrist, or front of wrist

    Debridement of nonunion site

    Packing with bone graft (from distal radius)

    Humpback deformities require structured graft from the hip

    Fixation with cannulated screw

Potential Complications

  • Infection, haematoma, nerve injury
  • Stiffness in wrist.
  • Non Union or malunion.

Post Op Care

  • Cast for 8 weeks or until bone healed.
  • Hand therapy once out of plaster.
  • Unable to use hand for heavy lifting until bone healed.
University Of Auckland Auckland Born Joint Surgery Fracs NZOA  University Of Auckland Auckland Born Joint Surgery Fracs