Vascularized bone grafting of scaphoid nonunions

Scaphoid fractures represent the most common carpal fracture and must always be included in the differential diagnosis for wrist pain in the athlete. In the short-term, nonunions may result in mild discomfort; however, the long-term sequelae of nonunions result in a predictable descent into wrist arthrosis. Athletes with excellent compensatory ability and multiple incentives to continue in sport may neglect these injuries until significant disruption of the scaphoid blood supply or arthritic changes have already occurred. The restoration and evaluation of scaphoid vascularity represent a challenging and important area of hand surgery. Magnetic resonance imaging and computed tomography (CT) scans have important roles in evaluating these injuries before and after surgery. Stable fixation and the use of local pedicled bone grafting or free vascularized grafts are the mainstays of treatment. Although technically more complex, better results have been reported with vascularized bone grafting and fixation compared with fixation and nonvascularized grafting alone, especially in cases of proximal pole avascular necrosis.