Scaphoid Fracture Non-Union – Repair with Bone Grafting 

Fractures of the scaphoid are relatively frequent wrist injuries. They are frquently overlooked because the area may not be noticeably swollen or intensely painful and if non-displaced may not be immediately evident on plain radiographs. It is frequently misdiagnosed as a wrist sprain and remain undiagnosed for months or years, leading to long-term consequences of painful arthritis. That is why a diagnosis of a wrist sprain should have repeat radiographs performed up to three weeks following the injury to pick up this overlooked condition to prevent the adverse long term sequelae.

A scaphoid fracture is usually caused by a fall on the outstretched hand or the result of a similar traumatic force, and occurs most often in young, active patients pursuing athletic sporting activities.

The scaphoid bone has a precarious blood supply and fractures of the waist may disturb the native blood supply to the proximal pole and result in avascular necrosis of that segment of bone, Therefore, even with a proper, timely, diagnosis and treatment it can lead to a failure of the fractured bone to heal resulting in a nonunion.

Diagnosis is made with a thorough physical examination and possibly additional imaging studies such as a bone scan, computed tomography (CT), or magnetic resonance imaging (MRI).


Scaphoid Bone Grafting

PA X-ray showing transverse waist non-united fracture of the scaphoid which failed to heal with an extended period of immobilization.







Scaphoid Bone Grafting   Lateral x-ray of same fracture.








Scaphoid Bone Grafting   MRI was performed to determine if the proximal pole was viable and amenable to bone grafting.







Scaphoid Bone Grafting   The tourniquet is released to confirm bleeding from the proximal pole of the scaphoid to ensure healing following bone grafting.







Scaphoid Bone Grafting   After the fracture site is debrided of fibrous tissue the defect is measured.







Scaphoid Bone Grafting   A appropriate sized cortico-cancellous bone auto-graft is harvested to be inserted into the defect.







Scaphoid Bone Grafting   The defect is packed with cancellous bone and the cortico-cancellous piece will be placed preventing volar collapse and a humpback deformity of the scaphoid.






Scaphoid Bone Grafting   The fracture site was immobilized with a Herbert screw.







Scaphoid Bone Grafting   Lateral view with healed fracture evident and humpback deformity corrected.








Case #2 Non-Union Scaphoid Fracture 

This patient’s diagnosis was missed and presented in a delayed fashion and underwent bone grafting and internal fixation to achieve a solid bony union.


Scaphoid Bone Grafting Scaphoid non-union evident on plain PA radiograph.







Bone graft inserted into defect.Scaphoid Bone Grafting