This 2008 narrative review by Kawamura and Chung covers the full management spectrum of scaphoid fractures and nonunions — from diagnostic workup and imaging algorithm to fixation technique selection and bone grafting strategy for established nonunions, with attention to the role of AVN in guiding surgical choice.
When evaluating a scaphoid nonunion, determine AVN status before choosing a graft: without AVN, nonvascularized grafting with screw fixation achieves ~94% union; with confirmed AVN (absent punctate bleeding at surgery), vascularized grafting roughly doubles the union rate over non-vascularized fixation.
Gadolinium MRI helps preoperatively, but don't let a negative scan override your intraoperative assessment.
This 2008 narrative review by Kawamura and Chung covers the full management spectrum of scaphoid fractures and nonunions — from diagnostic workup and imaging algorithm to fixation technique selection and bone grafting strategy for established nonunions, with attention to the role of AVN in guiding surgical choice.
When evaluating a scaphoid nonunion, determine AVN status before choosing a graft: without AVN, nonvascularized grafting with screw fixation achieves ~94% union; with confirmed AVN (absent punctate bleeding at surgery), vascularized grafting roughly doubles the union rate over non-vascularized fixation.
Gadolinium MRI helps preoperatively, but don't let a negative scan override your intraoperative assessment.