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Scaphoid Fixation

Percutaneous and open compression-screw fixation of scaphoid fractures.

98 citationsUpdated Oct 2026

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Overview

Scaphoid fixation addresses acute fractures, nonunions, and malunions, with management strategies dictated by fracture displacement and healing status. For acute injuries, nondisplaced fractures are effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention [2], though early internal fixation is increasingly favored [3]. Operative intervention is recommended for displaced fractures [2] and for acute fractures presenting with a scapholunate gap, which require open reduction and internal fixation with anatomic reduction and pin stabilization [8]. Percutaneous osteosynthesis serves as an attractive option for acute fractures [155], offering advantages such as minimal invasiveness, patient comfort, and low physical and economic morbidity, despite remaining a controversial technique [29]. Pediatric scaphoid fractures consistently demonstrate excellent outcomes [4].

In the setting of nonunion, high rates persist despite improvements in diagnosis and surgical techniques [3]. Successful screw fixation depends on careful patient selection and precise surgical technique rather than the specific implant used [1]. Most nonunions require bone grafting with fixation, as percutaneous fixation without graft is usually insufficient [5]. However, uncomplicated, nondisplaced, and nonangulated nonunions are candidates for minimally invasive bone grafting and compression screw fixation [25], and stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting, though well-designed studies are needed to define these indications [68]. Vascularized bone grafts are indicated for nonunions with established proximal pole avascular necrosis or those that have failed conventional bone grafting [50]. The limited combined approach is considered when a palmar wedge is required and the proximal pole is too small for rigid palmar screw fixation [41].

Regarding outcomes, virtually all scaphoid fractures that unite have a good outcome, regardless of malunion [35]. Different percutaneous management techniques have shown high healing and low complication rates [18], and the use of two headless compression screws is safe and effective [51]. Internal bone grafting remains a simple and effective method for selected cases [14]. A validated prognostic classification system is needed to allow comparisons between outcome studies [27].

Anatomy & Pathophysiology

Bony Anatomy

The scaphoid is a small, irregular S-shaped tubular bone located in the proximal carpal row on the radial aspect of the wrist [79]. It lies entirely within the wrist joint at a 45-degree plane to the longitudinal and horizontal axis of the wrist [79]. As the only carpal bone bridging the proximal and distal carpal rows, it acts as a tie-rod and a midcarpal joint "bridge," linking and synchronizing the motions of the two rows as part of the key intercalated segment [102, 79]. The bone is divided into three regions: the proximal pole, the waist, and the distal pole (tubercle) [102]. The proximal pole articulates with the scaphoid fossa of the distal radius and the lunate [102], while the distal pole features two distinct articular facets for the trapezium and trapezoid, forming the STT joint [79]. The capitate head articulates with a sulcus on the scaphoid located across the radial articular surface, providing a socket-like fit [79]. Due to gentle pronation and flexion, the distal pole sits ulnarly angulated relative to the proximal pole [79]. The intrascaphoid angle averages 40 ± 3 degrees in the coronal plane and 32 ± 5 degrees in the sagittal plane [102].

Over 80% of the scaphoid surface is covered with articular cartilage [79]. This extensive coverage reduces the bone's capacity for periosteal healing and increases the tendency for delayed union and nonunion [79]. The scaphoid is ridged across its nonarticular dorsoradial surface, along which critical dorsal ridge vessels traverse [79]. This dorsoradial ridge serves as the insertion point for both the dorsal component of the scapholunate and intercarpal ligaments [79]. The waist of the scaphoid has minimal or no perforating vasculature, and no vessels perforate the proximal dorsal cartilaginous area or through the scapholunate ligament [79].

Vascular Anatomy

The blood supply of the scaphoid is predominantly retrograde and meagre [79]. The major supply derives from two vascular pedicles originating from the scaphoid branches of the radial artery [79]. The dorsal branch enters via small foramina along the spiral groove and dorsal ridge, supplying 70% to 80% of the scaphoid proximally, including the proximal pole [79]. The volar branch enters via the scaphoid tubercle and supplies the remaining 20% to 30% of the distal scaphoid [79]. Anatomical variability exists in arterial foramina distribution: only 67% of scaphoid bones have arterial foramina throughout their length, including the distal, middle, and proximal thirds [83]. In 13% of cases, blood supply is predominantly in the distal third, while in 20%, most arterial foramina are located in the waist area with no more than a single foramen near the proximal third [83]. Consequently, one third of scaphoid fractures occurring in the proximal third may be without adequate blood supply [83].

The prevalence of osteonecrosis can be 35% in fractures at the proximal third level [83]. Proximal pole fractures have been reported to have an incidence of avascular necrosis (AVN) of 13% to 50% [102]. The more proximal the fracture, the more likely the bone is to be dysvascular and the higher the risk of nonunion [102]. The proximal pole also receives blood supply from the radioscapholunate ligament (ligament of Testut) and direct scapholunate branches from the palmar and dorsal transverse carpal arches [102]. Venous drainage from the proximal pole is via the dorsal ridge into the venae comitantes of the radial artery [102]. A scaphoid fracture breaches the relatively avascular radial and palmar capsular attachments and disrupts the inner longitudinal axial vasculature of the proximal bone substance [49]. The distal fragment is hardly ever affected by impairment of vascularity due to the arrangement of the axial vascular supply [49]. Whether a proximal fragment loses its blood supply depends on the location and spatial arrangement of the fracture, with greater risk in proximal locations [49]. Vascular impairment following a scaphoid fracture is a dynamic condition ranging from transient ischaemia to frank anoxia [49].

Ligamentous Anatomy

Ligamentous attachments of the scaphoid are predominantly found on the nonarticular dorsoradial surface [79]. Short intrinsic ligaments provide stability through attachments to other carpal bones, particularly the lunate, and merge with extrinsic ligaments and the wrist capsule [79]. There are no tendon attachments to the scaphoid [79]. The scapholunate interosseous ligament (SLIL) is a stout ligament connecting the scaphoid to the lunate and is the primary stabilizer [102]. The dorsal aspect of the SLIL is composed of transverse collagen fibers, whereas the palmar ligament is composed of oblique collagen fibers inserting to the volar capsular ligaments [102]. The dorsal portion of the SLIL is twice as strong as the palmar portion [102]. Only 20 to 30 degrees of motion is possible at an intact scapholunate interval [102]. The dorsal region of the SLIL resists palmar-dorsal translation and gap, whereas the volar portion resists rotation [102]. The proximal fibrocartilaginous region of the SLIL is the weakest mechanically and is suited to accept compression and shear loads at the radiocarpal joint [102].

The radioscaphocapitate (RSC) ligament originates from the volar radial aspect of the radius, crosses the volar concavity of the scaphoid waist, and proceeds ulnarly toward the capitate [102]. It does not attach to the bone itself but crosses the waist, acting as a sling across it allowing it to rotate [79]. The RSC ligament acts as a fulcrum around which the scaphoid rotates [102]. The scaphoid can fracture around the RSC ligament fulcrum at the waist [102]. The scaphocapitate ligament originates from the distal scaphoid and inserts into the border between the trapezoid facet and the capitate facet [102]. It inserts into the volar waist of the capitate distal to the RSC ligament [102]. The scaphocapitate ligament, along with the scaphotrapezial ligament, functions as a primary restraint of the distal pole [102].

Pathophysiology of Injury

Scaphoid fractures are most commonly caused by a fall on the outstretched palm resulting in severe hyperextension and slight radial deviation of the wrist [83]. The usual mechanism of injury is forced hyperextension of the wrist [39]. Scaphoid fractures account for almost 75% of all carpal fractures, making it the most frequently fractured carpal bone [39, 6]. Fracture occurs when the wrist is dorsiflexed to at least 95 degrees and radially deviated to at least 10 degrees [92]. In this position, the proximal pole of the scaphoid is held firmly between the radius, capitate, radioscaphocapitate ligament, and the palmar capsule [92]. With radial deviation, the radioscaphocapitate ligament is relaxed and unable to relieve increasing force applied to the radiopalmar aspect of the scaphoid [92]. During hyperextension, the proximal pole locks in the scaphoid fossa of the radius while the distal pole moves excessively dorsal [83]. The scaphoid usually fractures on tension at the radial-palmar side during hyperextension injuries [83].

With the hyperextension mechanism, a scaphoid fracture usually begins at the volar waist with tensile failure, propagating to the dorsal surface with compression loading until failure occurs [88]. The scaphoid fractures most frequently through the waist due to maximal bending movement and characteristically lower trabecular volume [92]. Fractures tend to occur at the waist partly because the RSC ligament acts as a fulcrum over which the scaphoid waist fractures [38]. Fractures of the waist are usually the result of shear forces across the scaphoid, while tubercle fractures appear to be caused by compression or avulsion [92]. 60% to 80% of scaphoid fractures occur at the scaphoid waist or midportion [83]. Proximal scaphoid fractures result from dorsal subluxation during forced hyperextension [88]. The size of a proximal pole fracture is dependent on the level of the proximal extent of the joint facet with the capitate [92]. Smaller proximal pole fractures can be caused by avulsion of the attachment of the scapholunate ligament [92]. Hyperextension past 95 degrees is the usual position of injury, though axial loading and hyperflexion have also been postulated [88]. 17% of patients with scaphoid fractures have other fractures of the carpus and forearm, including transscaphoid perilunar dislocations and trapezium fractures [83].

Pathophysiology of Nonunion and Instability

Nonunion occurs in 10% to 15% of all scaphoid fractures [88]. The risk of nonunion increases with delay of treatment for more than 4 weeks [88]. A fracture of the scaphoid that is unrecognized and untreated for 4 weeks or longer is at increased risk for nonunion [11]. The incidence of nonunion with delayed immobilization of scaphoid fractures ranged from 19% to 88% in several studies [11]. Other risk factors include proximal pole fractures, fracture displacement greater than 1 mm, osteonecrosis, and tobacco use [88]. The risk also increases with associated carpal instability, specifically dorsal intercalated segmental instability (DISI) with a scapholunate angle >60 degrees and a capitolunate angle >15 degrees [88]. Proximal pole fractures are at an increased risk of delayed union and nonunion compared with waist or distal pole fractures due to the more tenuous blood supply [21]. The relative risk of nonunion for proximal pole fractures managed nonoperatively was 7.5 times more compared with more distal fractures in a meta-analysis [57]. Proximal fractures are inexorably associated with at least temporary disruption of the interosseous blood supply to the proximal pole [79]. Temporary interruption of the blood supply to the proximal fragment is virtually certain with proximal pole fractures, but if stabilized, the proximal pole has the capacity to revascularize and heal [57]. Proximal pole fractures are uncommon, and the use of operative management is based on intuition more than data [57].

Nonunion rates for nondisplaced waist fractures treated with casting are 5% to 12% [88]. Nonunion rates for displaced scaphoid fractures treated nonoperatively can reach 50% [88]. In a 30-year follow-up review, 10% of patients with scaphoid fractures treated with thumb spica short-arm casts developed nonunion [88]. Neglected scaphoid fractures seldom heal with acceptable alignment due to the unique anatomical structure of the bone [6]. Reconstruction of the scaphoid in cases of non-union or malunion is exceedingly difficult and increases morbidity associated with extended hand immobilisation [6]. The potential for nonunion of the scaphoid is often ascribed to the meagre, largely retrograde blood supply [79].

Untreated displaced fractures of the waist usually angulate as the volar bone is reabsorbed, yielding a "humpback" flexion deformity of the scaphoid [88]. Humpback deformity is defined as a flexed scaphoid with an intrascaphoid angle >45 degrees, compared to a normal intrascaphoid angle of 24 degrees [88]. The proximal and distal fracture fragments can collapse, giving a characteristic flexed or "humpback" position on radiographs with an intrascaphoid angle of greater than approximately 30 degrees [92]. The resultant radial column shortening and extension of the proximal scaphoid pole releases the lunate to rotate into DISI under the influence of the attached triquetrum [88]. With an unstable displaced scaphoid fracture, joint compressive forces, trapezium–scaphoid shear stress, and capitolunate rotation moments act upon the scaphoid [92]. These forces lead to a dissociation of the proximal and distal carpal rows, permitting collapse into a lunate-extended posture [92]. The scaphoid assumes an anteverted position, while the lunate and triquetrum may subluxate forward and rotate dorsally [92]. The capitate and hamate subluxate dorsally and proximally, producing the dorsal intercalated segment instability (DISI) deformity [92].

Untreated scaphoid nonunion predictably progresses to arthritic change known as scaphoid nonunion advanced collapse (SNAC) [88]. Arthritic change in SNAC arises at the radial styloid articulation with the distal scaphoid pole (stage I), followed by degeneration of the scaphocapitate joint (stage II), and ultimately the midcarpal joint (stage III) [88]. Arthritic changes have been found in 97% of patients assessed at least 5 years after injury, with the degree of arthritic changes proportionate to the duration of nonunion [88]. 60% of patients with nonunion demonstrated radiographic evidence of radiocarpal osteoarthritis, while only 2% of the healed group demonstrated degenerative change [88].

Classification

Acute Fracture Classification

Herbert: This system accounts for fracture location and stability [24]. It categorizes acute scaphoid fractures into Type A (acute stable), Type B (acute unstable), Type C (delayed union), and Type D (established non-union) [143]. Type D non-unions are further subdivided into D1 (fibrous non-union) and D2 (sclerotic non-union/pseudoarthrosis) [143].

Cooney, Dobyns, and Linscheid: This classification evaluates acute scaphoid fractures based on stability [24]. Stable fractures are defined as distal pole fractures with displacement of less than 1 mm and normal intercarpal alignment [24]. Unstable fractures are defined as having a displacement greater than 1 mm [24].

Schernberg: This classification categorizes scaphoid fractures by anatomical location [62]. The types are: Type 1 (proximal pole), Type 2 (proximal part of the body), Type 3 (distal part of the body), Type 4 (tuberosity), Type 5 (distal segment), and Type 6 (partial fractures of the tuberosity) [62].

Nonunion Classification

Alnot: This classification grades scaphoid non-unions from I to IV based on scaphoid form, instability, intracarpal malalignment, and necrosis [74]. Grade I is a linear non-union without altered scaphoid form, instability, or intracarpal malalignment [74]. Grade II involves instability or malalignment, including anterior defect with proximal pole flexion on the distal tubercle inducing DISI, or mobile displacement non-union [74]. Grade III involves instability or reducible malalignment, subdivided into IIIA (isolated styloscaphoid arthritis) and IIIB (radial and/or intracarpal arthritis) [74]. Grade IV is defined by proximal fragment necrosis, subdivided into IVA (malalignment) and IVB (radioscaphoid and/or intracarpal arthritis) [74].

Other Considerations: A validated prognostic classification system for scaphoid nonunions is needed to allow comparisons between outcome studies [27].

Clinical Presentation

History and Mechanism

Patients classically present with wrist pain following a fall onto the outstretched hand, with almost 90% recalling a hyperextension injury [59]. The usual mechanism is forced hyperextension of the wrist [39], often resulting from falling on an outstretched hand, collision with a person or heavy obstacle, or a direct blow against an object [38]. Patients frequently report a history of hyperextension following a fall, sports activity, or punch injury [59]. It is critical to determine a history of previous trauma to the scaphoid to avoid treating a nonunion as an acute fracture [59]. Because scaphoid fractures are initially perceived as minor wrist injuries, they often present in a delayed fashion [21]. In chronic injuries, athletes may complain of an inability to perform a push-up [131].

Physical Examination

The main complaint is radial-sided wrist pain with localized tenderness over the scaphoid in the anatomical snuffbox region [59]. Patients usually present with pain on the radial side of the wrist, which may be accompanied by swelling [38]. In the acute phase, pain, swelling, ecchymosis, and tenderness around the scaphoid region may be present [59]. Acute fractures may exhibit swelling and bruising on the radial aspect of the wrist, whereas chronic injuries may present with dorsoradial wrist swelling [38]. Slight fullness in the anatomical snuffbox may be observed [39]. Pain and swelling in the anatomic snuffbox can be subtle, leading to late presentation [125].

Special Tests and Diagnostic Sensitivity

Precisely localized tenderness in the anatomical snuffbox is an important diagnostic sign [39]. "Snuffbox tenderness" is synonymous with scaphoid fracture, predominantly for waist fractures, which represent 70% of scaphoid fractures [38]. Proximal pole fractures are the second most common type at 20%, while distal pole fractures are the least common at 10% [38]. Pain on longitudinal compression of the thumb (scaphoid axial compression test) is also a sign of scaphoid fracture [38]. Examination must include pressure backwards over the scaphoid tubercle, palpation over the proximal pole, and telescoping of the thumb base [39]. If any of snuffbox tenderness, scaphoid tubercle pressure, proximal pole palpation, or thumb telescoping are positive, suspicion for a scaphoid fracture should be high [39].

No single sign has been found to be adequately sensitive or specific for scaphoid fracture [59]. The following clinical signs have variable diagnostic performance: * Anatomical snuffbox tenderness: Sensitivity of 87–100% and specificity of 3–98% [59]. * Axial compression of the thumb: Sensitivity of 48–100% and specificity of 22–97% [59]. * Scaphoid tubercle tenderness: Sensitivity of 82–100% and specificity of 17–57% [59]. * Pain on ulnar deviation: Sensitivity of 67–100% and specificity of 17–60% [59]. * Pain on radial deviation: Sensitivity of 67–90% and specificity of 31–42% [59]. * Reduced range of movement of the thumb: Sensitivity of 65–66% and specificity of 38–59% [59]. * Thumb–index finger pinch: Sensitivity of 75–79% and specificity of 44–76% [59].

ASB tenderness is oversensitive and has poor specificity [59]. In a study of 246 patients with a suspected fracture, ASB tenderness had a sensitivity of 90% and a specificity of 40% [59]. In the same study, scaphoid tubercle tenderness had a sensitivity of 87% and a specificity of 57% [59]. The use of one clinical sign in isolation is insufficient for diagnosis [59]. A combination of ASB tenderness, scaphoid tubercle tenderness, and ASB pain on longitudinal compression of the thumb generated a sensitivity of 100% and a specificity of 74% [59]. These combined findings were valid only for the first 24 hours after injury [59]. If all three tests—ASB tenderness, scaphoid tubercle tenderness, and scaphoid axial compression—are positive, there is 87% to 100% sensitivity and 74% specificity for scaphoid fracture [38]. Pain on thumb–index finger pinch and ASB pain on pronation of the forearm were most suggestive of a true scaphoid fracture [59]. The best predictors of fracture within 72 hours of injury were the absence of pain on ulnar deviation of the wrist and pain on thumb–index finger pinch [59]. Scaphoid tubercle tenderness was most predictive at week 2 [59].

Patients with a clinical scaphoid score (CSS) of 4 or higher require an MRI [59]. The CSS uses three clinical tests: tenderness in the ASB with the wrist in ulnar deviation (3 points), tenderness over the scaphoid tubercle (2 points), and pain upon longitudinal compression of the thumb (1 point) [59].

Occult Fractures and Initial Assessment

Up to 30% to 40% of scaphoid fractures are not identified on initial assessment and investigation with standard four-view radiographs [59]. Patients subsequently found to have a fracture confirmed on repeated assessment and radiologic imaging, most frequently at 10 to 14 days after injury, are said to have had an occult fracture of the scaphoid [59]. Radiographs are often negative at initial presentation approximately 25% of the time [131]. The incidence of fractures of the scaphoid in patients diagnosed initially as a clinical fracture is very low [26]. If the X-ray looks normal but clinical features are suggestive of a fracture, the patient must not be discharged [39]. The diagnosis has to be confirmed one way or another [39].

The usual advice is to return for a second X-ray 2 weeks later [39]. Meanwhile, the wrist is immobilized in a cast extending from the upper forearm to just short of the metacarpophalangeal joints of the fingers, but incorporating the proximal phalanx of the thumb [39]. The wrist is held dorsiflexed and the thumb forwards in the 'glass-holding' position (the so-called scaphoid plaster) [39]. An alternative is to arrange an MRI scan or, if not available, a CT scan, which will definitely detect the fracture even if it was not visible on the X-ray [39].

Patients with a suspected occult scaphoid fracture are reevaluated after 1 to 2 weeks of immobilization in a forearm cast or splint [122]. An examination by a specialist after the injury has become less painful allows for a more accurate physical examination and substantially increases the sensitivity of detecting a scaphoid fracture [122]. If the probability of a fracture remains unacceptable and new scaphoid specific radiographs are also normal, the patient can either continue with immobilization or advanced imaging (typically CT or MRI) can be used to attempt to exclude a fracture [122]. Six weeks of splint immobilization with normal scaphoid radiographs is likely sufficient [122]. The higher the pretest odds of a fracture, the more likely an imaging diagnosis of a fracture will correlate with a true fracture [122]. The lower the pretest odds, the less likely that a radiologic diagnosis of a fracture will correspond with a true fracture [122]. Patients with more pressing needs to diagnose a fracture can be considered for more sophisticated imaging early on [122].

If clinical suspicion is high for fracture but radiographs are negative, the athlete should be placed in a short arm-thumb spica splint, and an MRI should be obtained [131]. If radiographs are equivocal, ultrasonography can be used to diagnose fracture or radiography can be repeated after 2 weeks of immobilization to assess for evidence of healing fracture [125]. Suspected fractures must be immobilized in a thumb spica cast or splint [125]. If the scaphoid fat stripe is abnormal or missing, a second X-ray and clinical examination ought to be carried out after about two weeks [13]. The frequency of non-union will not increase if correct immobilization is commenced with this delay [13].

Investigations

Clinical Examination

Patients with scaphoid fractures classically present with wrist pain following a fall onto the outstretched hand, with almost 90% recalling a hyperextension injury [59]. Anatomical snuffbox tenderness has a sensitivity of 87–100% and a specificity of 3–98% for scaphoid fracture [59]. Axial compression of the thumb has a sensitivity of 48–100% and a specificity of 22–97% for scaphoid fracture [59]. Scaphoid tubercle tenderness has a sensitivity of 82–100% and a specificity of 17–57% for scaphoid fracture [59]. Pain on ulnar deviation has a sensitivity of 67–100% and a specificity of 17–60% for scaphoid fracture [59]. Pain on radial deviation has a sensitivity of 67–90% and a specificity of 31–42% for scaphoid fracture [59]. Reduced range of movement of the thumb has a sensitivity of 65–66% and a specificity of 38–59% for scaphoid fracture [59]. Thumb–index finger pinch has a sensitivity of 75–79% and a specificity of 44–76% for scaphoid fracture [59]. No single clinical sign has been found to be adequately sensitive or specific for the diagnosis of scaphoid fracture [59]. A combination of anatomical snuffbox tenderness, scaphoid tubercle tenderness, and anatomical snuffbox pain on longitudinal compression of the thumb generates a sensitivity of 100% and a specificity of 74% for scaphoid fracture within the first 24 hours after injury [59].

Radiography

Standard radiographic views for scaphoid fracture workup include posteroanterior, lateral, oblique, and scaphoid views [58]. A true scaphoid pisiform capitate lateral radiograph allows a true assessment of carpal alignment [58]. The scaphoid view is taken with the wrist in ulnar deviation to take the scaphoid out of its usual position of flexion and pronation, allowing a full view of the scaphoid bone with minimal overlap from neighboring bones [58]. A clenched pencil view is the best view to assess associated dynamic scapholunate widening and shows SNAC and scapholunate advanced collapse wrist changes better than standard PA views [58]. Radiographs are initially nondiagnostic in more than 30% of scaphoid fracture cases [93]. Plain radiography is approximately 50% sensitive for the detection of a scaphoid fracture [86]. Conventional radiographic imaging is accurate and moderately reliable in diagnosing union of scaphoid waist fractures at 6 weeks follow-up [72]. Conventional radiographic imaging is reliable but inaccurate in diagnosing nonunion of scaphoid waist fractures at 6 weeks follow-up [72]. Radiographs and clinical examination should not be used to determine duration of immobilization for nondisplaced scaphoid fractures because they are unreliable for diagnosis of union [95]. The frequency of non-union will not increase if correct immobilization is commenced with a delay of about two weeks when the scaphoid fat stripe is abnormal or missing [13]. A method allowing direct visualization of the long axis of the scaphoid in the lateral plane facilitates easy determination of the presence and amount of angulation at the fracture site in scaphoid nonunions [164].

Advanced Imaging

MRI has the highest sensitivity, specificity, and accuracy (all >95%), with high positive and negative predictive values, at less than 24 hours for scaphoid fracture diagnosis [93]. All advanced imaging modalities including bone scan, ultrasonography, CT, and MRI are better for ruling out rather than ruling in a scaphoid fracture [93]. MRI is the definitive way to confirm or exclude a diagnosis of scaphoid fracture if the technique is available [39]. A normal MRI study as early as 2 days after injury has a negative predictive value of 100% for scaphoid fracture [86]. CT scan is more sensitive than plain radiography for diagnosing a scaphoid fracture [39]. CT scan is particularly useful in confirming the alignment of the bone fragments if surgery is planned or to confirm whether the fracture has united or not [39]. Routine use of a week 4 CT scan is valuable in the early management of displaced scaphoid waist fractures to predict the likelihood of union with nonoperative treatment [15]. Contrast-enhanced MRI scans can provide useful information on scaphoid perfusion but cannot replace intraoperative judgment of vascularity [149]. CBCT is less sensitive in the detection of carpal fractures than MRI and is not an equivalent tool to exclude scaphoid fractures [154]. Computed tomography or magnetic resonance imaging can be helpful as an adjunct to standard x-rays to evaluate the cartilage of the radiolunate joint and confirm the SLAC stage [56]. Three-dimensional computer simulations are useful for accurate correction of scaphoid nonunions and proper screw placement [37]. The authors recommend that all acute scaphoid fractures should be assessed with MRI scans or tomography and classified as undisplaced and displaced [30].

Treatment

Non-Operative

A restricted period of cast immobilisation is recommended for the initial treatment of non-displaced scaphoid fractures [12]. Non- and minimally displaced scaphoid waist fractures are best treated conservatively [40]. Both casting and surgery are reliable treatments for nondisplaced scaphoid waist fractures, and the outcomes are comparable [159]. Cast immobilization with the thumb free is less disabling and does not seem to prolong healing time or impair recovery [159]. Partial union of the scaphoid is a common occurrence but, in most cases, it progresses to full union without the need for prolonged plaster immobilization [9]. If the scaphoid fat stripe is abnormal or missing, a second X-ray and clinical examination ought to be carried out after about two weeks, as the frequency of non-union will not increase if correct immobilization is commenced with this delay [13].

Operative

Indications: Early internal fixation is increasingly favored even for nondisplaced fractures [3]. Scaphoid fractures diagnosed on a delayed basis should be considered for operative treatment regardless of displacement [11]. Suggested treatment for acute scaphoid fracture with scapholunate gap is open reduction and internal fixation of the scaphoid with anatomic reduction and pin stabilization of the scaphoid [8]. In most scaphoid nonunion, as percutaneous fixation without bone graft is insufficient, bone grafting with fixation is usually recommended [5]. Uncomplicated scaphoid nonunions that are nondisplaced and nonangulated are candidates for the minimally invasive bone grafting and compression screw fixation procedure [25]. While traditional treatment for scaphoid nonunion involves open debridement and bone grafting, some publications suggest that stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting, though well-designed clinical studies are needed to better define appropriate indications [68].

Surgical Approach / Technique: Percutaneous screw fixation provides excellent and reliable results for acute scaphoid fractures [32]. Acute percutaneous fixation of the scaphoid offers advantages including minimal invasive surgery, patient comfort and low physical and economic morbidity [29]. The technique of cannulated variable pitch compression screw fixation using a limited dorsal approach permits accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union [28]. Accurate fixation of scaphoid fractures is achieved without unnecessary drilling or repeated screw insertion using a modified technique for Herbert screw insertion, minimizing risk of further scaphoid insult [10]. In the treatment of all but very proximal fractures of the scaphoid, the palmar approach is used for Herbert screw insertion [150]. Open reduction and internal fixation with AO mini fragment lag screws can be performed using either anterior or dorsal approaches depending on the site of the fracture and its configuration [71]. The dorsal distal scaphoid approach was found to be technically easy to perform in 12 cases [123]. The technique of fixation and grafting after limited debridement is an effective and efficient method of treating nondisplaced scaphoid nonunions without avascular necrosis [110].

Implant Selection: Proximal pole fractures should be approached dorsally to maximize stability [20]. Fixation stability for proximal pole fractures can be improved by placing a percutaneous screw from the distal scaphoid into the capitate to lock midcarpal motion and decrease forces acting on the proximal pole fracture site [20]. A 1.6-mm K-wire can be placed in the second or third web-space into the capitate and the lunate as an alternative to a screw for locking midcarpal motion in proximal pole fractures [20]. Herbert-screw fixation with bone-grafting is effective for the treatment of nonunion of the scaphoid [146]. Retrograde dorsal Herbert screw fixation and adjunctive bone grafting has been successful in the treatment of small proximal pole nonunions and displaced proximal pole fractures [158]. The Herbert scaphoid screw has marginal fixation capabilities and its use probably should be limited to instances where size constraints preclude the use of a larger screw [144]. The Heune scaphoid screw provides the greatest compressive fixation of the screws tested but is too large for routine use [145].

Adjuncts: Not all proximal pole scaphoid nonunions with avascular necrosis require vascularized bone graft or a formal open incision; if the distal scaphoid is well perfused and the proximal pole can be secured rigidly after percutaneous bone grafting, nonunion repair and healing can proceed [17]. Nonvascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis [133]. The indications, contraindications, and technique of free vascularized medial femoral condyle bone grafting are presented for the treatment of scaphoid nonunions associated with proximal pole avascular necrosis and humpback deformities [142]. The rationale, indications, contraindications, technique and results of bone grafting scaphoid nonunions with grafts harvested from the medial femoral condyle are presented [64]. A corticocancellous graft harvested from the distal radius can be used for unstable scaphoid nonunion treatment [160]. If the proximal segment is avascular during scaphoid fracture fixation, a dorsal approach is used to incorporate a vascularized bone graft from the distal radius [71].

Other Considerations: Functional wrist range of motion and grip strength were achieved in all patients treated with retrograde compression screw fixation of acute proximal pole scaphoid fractures [23]. The results of distal scaphoid resection arthroplasty for degenerative arthritis secondary to scaphoid nonunion revealed increased range of wrist motion in all planes in 85% of patients, grip improved by 134%, and 13 patients experienced complete relief of pain [70]. A palmar approach to scapho-trapeziotrapezoid arthrodesis with an alternate form of fixation has been described [7].

Complications and Biomechanics: The most common complications of scaphoid screw fixation are placement of screws that are too long and eccentric screw placement [20]. Screw protrusion into the joint or impact against the opposite cortex can cause fracture displacement rather than compression as the screw is advanced [20]. Eccentric screw placement risks poor biomechanical stability [20]. At least 4 threads of the screw should be across both sides of the fracture [20]. An arthroscope can be placed into the joint to better determine screw position if there is potential for screw penetration into the joint [20]. Dorsal tendon damage can be minimized by careful spreading to tissue down to the joint capsule as wires are driven back out retrograde [20].

Adjunctive Technologies: Computer-assisted technology for scaphoid fixation is problematic due to the cost of preoperative CT, expensive and time-consuming image processing, and the infeasibility of attaching a reference body directly to the scaphoid [151]. Registration for computer-assisted scaphoid fixation is problematic because the small size of the scaphoid limits fiducial marker implantation and open exposure would be needed to collect surface points [151]. Intraoperative computer-generated guides based on preoperative 3-dimensional analysis can be used for scaphoid reconstruction [157].

Imaging and Assessment: All acute scaphoid fractures should be assessed with MRI scans or tomography and classified as undisplaced and displaced [30]. Routine use of a week 4 CT scan is valuable in the early management of scaphoid fractures to predict the likelihood of union with nonoperative treatment [15]. Approximately 60 to 80% of scaphoid fractures involve the waist, followed by 25% in the distal third and 5 to 10% in the proximal third [24]. Distal pole scaphoid fractures healed at an average of 6 weeks, scaphoid waist fractures at 12 weeks, and proximal pole fractures at 12 weeks to 6 months [24]. Stable scaphoid fractures are noted to have a displacement of less than 1 mm, normal intercarpal alignment, and distal pole location [24]. Unstable scaphoid fractures are defined as having greater than 1 mm displacement [24].

Complications

Screw Placement and Fixation Errors

The most common complications of scaphoid fixation are screws that are too long and eccentric screw placement [20]. A screw that is too long may protrude into the joint [20]. Alternatively, it may impact the opposite cortex and cause fracture displacement rather than compression as it is advanced [20]. The operation for scaphoid osteosynthesis is technically demanding and has a high incidence of screw malpositioning which correlates with failure to achieve union [175, 176]. Failure of acute scaphoid fracture fixation often results from malreduction, failure to restore length, or compromised vascularity [33]. If there is potential for screw penetration into the joint, which can be difficult to assess fluoroscopically, an arthroscope can be placed into the joint to better determine screw position [20].

Soft Tissue and Nerve Injury

A patient treated with dorsal Herbert screw fixation suffered a neurapraxia of the superficial branches of the radial nerve in the dorsum of the hand, with sensation returning to normal within 60 days [147]. Complications of combined vascularized distal radius graft and iliac crest bone grafting include infection, damage to the palmar cutaneous nerve, and stiffness of the wrist [134].

Hardware-Related Complications

One patient treated with trephine bone grafting and screw fixation complained of impingement from an AO screw head, which required removal [115]. An intraosseous screw is preferred to avoid screw head impingement [115]. To avoid volar scaphoid plate impingement, plates must be adjusted to adequately fit the volar surface, placed distal to the pronator square wrist line, and clearly visualized on intraoperative fluoroscopy [103].

Nonunion and Healing Failure

With a delay of treatment of more than four weeks, the incidence of nonunion is considerably increased [61]. A delay of immobilization up to four weeks does not increase the frequency of nonunion [61]. Displaced waist fractures have a threefold increase in the incidence of nonunion and a two-week prolongation of time to bony union compared to nondisplaced fractures [61]. The relative risk of nonunion for proximal scaphoid fractures is 7.5 compared with more distal fractures managed nonoperatively [96]. In a series of 10 scaphoids that failed initial bone grafting and underwent repeat grafting, 7 united, but only 3 of those patients were asymptomatic at follow-up [109]. Of the 4 patients with symptomatic scaphoid unions after failed initial grafting, one subsequently had a wrist fusion, a second had multiple procedures without pain relief, and two were considering a salvage procedure [109]. The natural history of nonunion of the scaphoid is not as severe as has been reported in the literature [19]. Bone healing may occur with persistent malunion, altered wrist motion, and decreased grip strength [66]. The data to date have demonstrated that the advantages of surgical fixation are transient, the possible complications must not be underestimated, and the long-term outcomes of surgical fixation are incompletely understood [168].

Arthrodesis and Salvage Procedure Complications

Common complications of 4-corner fusion using retrograde headless compression screws include nonunion, infection, decreased range of motion, and dorsal radiocarpal impingement [166]. Worse outcomes are expected in the setting of scaphoid nonunions with radioscaphoid arthritis [111]. In a series of 14 patients undergoing vascularized pedicle bone grafting, 3 of the 4 patients with preoperative radioscaphoid arthritis had a poor or fair result [111]. The outcome of scaphoid excision and 4-corner arthrodesis is favorable at one year and does not deteriorate significantly between one and 10 years [31].

Recovery

Light activity (weeks): The evidence provided does not specify a typical week range for light activity, desk work, driving, or light activities of daily living.

Full activity (months): The evidence provided does not specify a typical month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The evidence provided does not specify a typical month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Percutaneous scaphoid fixation for acute fractures is a rapid intervention that can be performed on a daycase basis and leads to rapid functional recovery [169]. Functional wrist range of motion and grip strength were achieved in all patients following retrograde compression screw fixation of acute proximal pole scaphoid fractures [23].

Functional milestones: Vascularized bone grafting for scaphoid nonunion results in the improvement of patient-derived outcomes, with high rates of return to preinjury activity levels and patient satisfaction [163]. Arthroscopic reduction and osteosynthesis of chronic unstable scaphoid nonunion has positive effects on the recovery of clinical wrist function, although it is limited for restoration of normal carpal alignment [167]. Healing achieved using arthroscopically assisted bone grafting was superior to that achieved using percutaneous screw fixation alone for the treatment of scaphoid delayed unions and nonunions [172].

Other Considerations: If there is potential for screw penetration into the joint, an arthroscope can be placed into the joint to better determine screw position [20]. Accurate fixation is achieved without unnecessary drilling or repeated screw insertion, minimizing risk of further scaphoid insult [10]. Three-dimensional computer simulations were found as useful for accurate correction of scaphoid nonunions and proper screw placement, which consequently leads to good clinical results [37]. The natural history of nonunion of the scaphoid is not as severe as has been reported in the literature, although the magnitude of the difference is not known at this time [19]. Scaphoid fractures that are unrecognized and untreated for 4 weeks or longer are at increased risk for nonunion [11]. The incidence of nonunion with delayed immobilization of scaphoid fractures in several studies ranged from 19% to 88% [11]. Neglected scaphoid fractures seldom heal with acceptable alignment, which often leads to complications in their management [6]. In cases of non-union or malunion, reconstruction of the scaphoid is exceedingly difficult, and this increases the chances of morbidity already associated with an extended period of hand immobilisation [6]. Scaphoid nonunions with minimal displacement, maintained mechanical alignment of the carpus, and an intact cartilage cap represent a stable pattern that can be treated by restoring mechanical stability [47].

Key Evidence

• [L4] Successful treatment of scaphoid nonunions with screw fixation does not depend on the implant used but rather on careful selection of patients and precise surgical technique. [1] (10.1016/s0363-5023(09)91122-4)
• [L1] Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures. [2] (10.2106/jbjs.rvw.15.00073)
• [L5] This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions, highlighting that despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures. [3] (10.1016/j.jhsa.2008.04.026)
• [L1] Pediatric scaphoid fractures have excellent outcomes. [4] (10.1177/1558944717735948)
• [L4] In most scaphoid nonunion, as percutaneous fixation without bone graft is insufficient, bone grafting with fixation is usually recommended. [5] (10.1142/s2424835518300049)
• [L4] [6] (10.1016/j.injury.2009.07.078)
• [L4] We describe a palmar approach to scapho-trapeziotrapezoid arthrodesis with an alternate form of fixation. [7] (10.1016/s0363-5023(09)90037-5)
• [L5] Suggested treatment for this condition in the acute stage is open reduction and internal fixation of the scaphoid with anatomic reduction and pin stabilization of the scaphoid. [8] (10.1016/s0363-5023(89)80051-6)
• [L3] Partial union of the scaphoid is a common occurrence but, in most cases, it progresses to full union without the need for prolonged plaster immobilization. [9] (10.1016/j.jhsb.2005.05.007)
• [L5] Accurate fixation is achieved without unnecessary drilling or repeated screw insertion, minimizing risk of further scaphoid insult. [10] (10.1016/s0363-5023(87)80182-x)
• [L5] [11] (10.5435/00124635-200007000-00003)
• [L4] [12] (10.1016/j.injury.2008.10.028)
• [L4] If the scaphoid fat stripe is abnormal or missing, a second X-ray and clinical examination ought to be carried out after about two weeks, as the frequency of non-union will not increase if correct immobilization is commenced with this delay. [13] (10.1016/0266-7681_88_90058-7)
• [L4] Management of scaphoid nonunions by internal bone grafting is a simple and effective method that can be applied successfully in selected cases. [14] (10.1097/bth.0000000000000137)
• [L2] Routine use of such a scan is valuable in the early management of scaphoid fractures. [15] (10.1177/1753193411403092)
• [L5] Not all proximal pole scaphoid nonunions with avascular necrosis require vascularized bone graft or a formal open incision; if the distal scaphoid is well perfused and the proximal pole can be secured rigidly after percutaneous bone grafting, nonunion repair and healing can proceed. [17] (10.1097/01.blo.0000205886.66081.9d)
• [L4] Different techniques of percutaneous management of scaphoid fractures have shown high healing and low complication rates. [18] (10.1097/bth.0b013e3181877644)
• [L5] We conclude that the natural history of nonunion of the scaphoid is not as severe as has been reported in the literature, although the magnitude of the difference is not known at this time. [19] (10.1016/0363-5023(93)90235-u)
• [L5] [20] (10.1016/j.jhsa.2008.04.023)
• [L4] [21] (10.1055/s-0040-1701512)
• [L4] Functional wrist range of motion and grip strength were achieved in all patients. [23] (10.1053/jhsu.1999.1206)
• [L5] [24] (10.5435/jaaos-d-22-01210)
• [L4] Uncomplicated scaphoid nonunions that are nondisplaced and nonangulated are candidates for the minimally invasive bone grafting and compression screw fixation procedure described. [25] (10.1016/j.jhsa.2008.03.004)
• [L4] The incidence of fractures of the scaphoid in patients diagnosed initially as a clinical fracture of the scaphoid is very low. [26] (10.1016/s0266-7681(85)80065-6)
• [L4] There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies. [27] (10.1177/1753193417739510)
• [L5] The technique is simple permitting accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union. [28] (10.1097/01.bth.0000191422.26565.25)
• [L4] Acute percutaneous fixation of the scaphoid remains a very controversial technique, but literature points at many advantages including minimal invasive surgery, patient comfort and low physical and economic morbidity. [29] (10.1016/s1297-3203(03)00026-x)
• [L3] The authors recommend that all acute scaphoid fractures should be assessed with MRI scans or tomography and classified as undisplaced and displaced. [30] (10.1016/s0363-5023(03)80355-6)
• [L4] The outcome of scaphoid excision and 4-corner arthrodesis is favorable at one year and does not deteriorate significantly between one and 10 years. [31] (10.1016/j.jhsa.2010.01.025)
• [L4] Percutaneous screw fixation provides excellent and reliable results for acute scaphoid fractures. [32] (10.1016/j.hcl.2011.06.003)
• [L4] Failure of acute scaphoid fracture fixation often results from malreduction, failure to restore length, or compromised vascularity. [33] (10.1016/j.jhsa.2014.02.023)
• [L3] Virtually all scaphoid fractures which unite have a good outcome, regardless of malunion. [35] (10.1177/1753193408093327)
• [L4] Three-dimensional computer simulations were found as useful for accurate correction of scaphoid nonunions and proper screw placement, which consequently leads to good clinical results. [37] (10.1097/01.blo.0000154204.72825.a5)
• [L2] Non- and minimally displaced scaphoid waist fractures are best treated conservatively. [40] (10.1016/j.jhsa.2015.03.007)
• [L4] This technique should be considered for scaphoid nonunion that require a palmar wedge and at the same time the proximal pole is too small for assure a rigid fixation by a palmarly inserted screw. [41] (10.1016/s0363-5023(03)80408-2)
• [L4] Scaphoid nonunions with minimal displacement, maintained mechanical alignment of the carpus, and an intact cartilage cap represent a stable pattern that can be treated by restoring mechanical stability. [47] (10.1016/j.jhsa.2025.07.019)
• [L5] [49] (10.1016/s0266-7681(95)80036-0)
• [Paper] The indications for vascularized bone grafts in scaphoid nonunion are any nonunion with established proximal pole avascular necrosis and nonunion that has failed a previous attempt at conventional bone grafting. [50] (10.1097/00130911-200303000-00007)
• [L4] The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective. [51] (10.1016/j.jhsa.2014.02.030)
• [L4] [61] (10.1016/0266-7681(88)90058-7)
• [L4] [62] (10.1016/s0266-7681(05)80048-8)
• [Paper] The rationale, indications, contraindications, technique and results of bone grafting scaphoid nonunions with grafts harvested from the medial femoral condyle are presented. [64] (10.1016/j.main.2010.09.009)
• [L3] [66] (10.1053/jhsu.1999.0761)
• [L5] While traditional treatment for scaphoid nonunion involves open debridement and bone grafting, some publications suggest that stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting, though well-designed clinical studies are needed to better define appropriate indications. [68] (10.1016/j.jhsa.2018.03.048)
• [L4] The results of this procedure in 19 patients revealed increased range of wrist motion in all planes in 85%; grip improved by 134%, and 13 patients experienced complete relief of pain. [70] (10.1097/00130911-200206000-00009)
• [L4] [71] (10.1054/jhsb.1999.0262)
• [L2] Conventional radiographic imaging is accurate and moderately reliable in diagnosing union, and reliable but inaccurate in diagnosing nonunion of scaphoid waist fractures at 6 weeks follow-up. [72] (10.1007/s00402-014-2147-9)
• [L4] [74] (10.1016/j.otsr.2011.08.008)
• [L1] A meta-analysis showed that the relative risk of nonunion for these fractures is 7.5 compared with more distal fractures, also managed nonoperatively. [96] (10.1177/1753193412451424)
• [L1] [103] (10.1016/j.injury.2025.112759)
• [L4] [109] (10.1016/s0363-5023(89)80078-4)
• [L4] The technique described is an effective and efficient method of treating nondisplaced scaphoid nonunions without AVN. [110] (10.1016/j.jhsa.2015.05.022)
• [Paper] [111] (10.1097/01.bth.0000231579.32406.17)
• [L4] [115] (10.1053/jhsu.2001.26024)
• [L4] In 12 cases, the dorsal distal scaphoid approach was found to be technically easy to perform. [123] (10.1177/1753193408097858)
• [L4] Nonvascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. [133] (10.1177/1753193417730657)
• [L5] [134] (10.1097/bth.0b013e318166d364)
• [L5] The indications, contraindications, and technique of free vascularized medial femoral condyle bone grafting are presented for the treatment of scaphoid nonunions associated with proximal pole avascular necrosis and humpback deformities. [142] (10.1097/bth.0b013e3180cab17c)
• [L4] [143] (10.1016/0266-7681(88)90178-7)
• [L3] The Herbert scaphoid screw has marginal fixation capabilities and its use probably should be limited to instances where size constraints preclude the use of a larger screw. [144] (10.1016/s0363-5023(10)80058-9)
• [L5] The Heune scaphoid screw provides the greatest compressive fixation of the screws tested but is too large for routine use. [145] (10.1016/s0363-5023(87)80002-3)
• [L4] Herbert-screw fixation with bone-grafting is effective for the treatment of nonunion of the scaphoid. [146] (10.2106/00004623-199901000-00007)
• [L3] [147] (10.1016/0363-5023(93)90044-4)
• [L2] Contrast-enhanced MRI scans can provide useful information on scaphoid perfusion but cannot replace intraoperative judgment of vascularity. [149] (10.1177/1753193410375776)
• [L5] [150] (10.1016/s0363-5023(09)90036-3)
• [L5] [151] (10.1055/s-0033-1357760)
• [L5] However, they acknowledge that CBCT is less sensitive in the detection of carpal fractures than MRI and therefore not an equivalent tool to exclude scaphoid fractures. [154] (10.1177/1753193418758846)
• [L3] Percutaneous scaphoid osteosynthesis is an attractive option for acute scaphoid fractures. [155] (10.1055/s-0040-1716352)
• [L3] [157] (10.1016/j.jhsa.2015.10.009)
• [L4] [158] (10.1016/s0363-5023(89)80050-4)
• [L2] [159] (10.1016/j.jhsa.2008.12.028)
• [L5] [160] (10.1097/bth.0b013e31824cc258)
• [L2] VBG for scaphoid nonunion results in the improvement of patient-derived outcomes, and high rates of return to preinjury activity levels and patient satisfaction. [163] (10.1177/1558944716643080)
• [Paper] This method allows direct visualization of the long axis of the scaphoid in the lateral plane for easy determination of the presence and amount of angulation at the fracture site. [164] (10.1016/s0363-5023(89)80056-5)
• [L5] [166] (10.1097/bth.0b013e3182688c6a)
• [L4] Arthroscopic reduction and osteosynthesis of chronic unstable scaphoid nonunion is limited for restoration of normal carpal alignment but has positive effects on the recovery of clinical wrist function. [167] (10.1016/j.arthro.2014.08.035)
• [L1] The data to date have demonstrated that the advantages of surgical fixation are transient, the possible complications must not be underestimated, and the long-term outcomes of surgical fixation are incompletely understood. [168] (10.1016/j.jhsa.2008.12.027)
• [L4] We have found percutaneous scaphoid fixation for acute fractures a rapid and very satisfactory intervention with can easily be performed on a daycase basis and leads to a rapid functional recovery. [169] (10.1016/s0020-1383(98)00033-3)
• [L3] Healing achieved using arthroscopically assisted bone grafting was superior to that achieved using percutaneous screw fixation alone for the treatment of scaphoid delayed unions and nonunions. [172] (10.1055/s-0039-1693146)
• [L4] The operation is technically demanding and there is a high incidence of malpositioning of the screw which correlates with failure to achieve union. [175] (10.1016/0266-7681_87_90054-4)
• [L4] The operation is technically demanding and there is a high incidence of malpositioning of the screw which correlates with failure to achieve union. [176] (10.1016/0266-7681(87)90054-4)

See Also

• Scaphoid Fracture

References

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