Retrospective review of 47 scaphoid non-unions (5–53 years duration) in 46 symptomatic patients. Describes the radiographic natural history of untreated non-union and identifies which fracture characteristics predict progression to wrist arthritis. Establishes a three-stage classification and the 10-year displacement threshold that drives current treatment recommendations.
A young patient with a "minimally symptomatic" scaphoid non-union is not a safe observation candidate if displacement is present. This paper is why we treat displaced non-unions regardless of symptoms: 100% of cases with radioscaphoid or generalized wrist arthritis had displacement and instability, and after 10 years even initially stable non-unions cross that threshold at a rate exceeding 88%.
In clinic, measure both the radiolunate angle and the scapholunate angle when assessing a chronic non-union. When degenerative change obscures the scaphoid, the lunate silhouette remains readable — a radiolunate angle ≥10° is your instability call.
For the truly asymptomatic patient with a confirmed undisplaced, stable non-union, surgery is not mandatory, but the conversation must include the near-certainty of late arthritic change. Fracture location and configuration add nothing to prognosis. Displacement and instability are the only radiographic variables that matter.
Retrospective review of 47 scaphoid non-unions (5–53 years duration) in 46 symptomatic patients. Describes the radiographic natural history of untreated non-union and identifies which fracture characteristics predict progression to wrist arthritis. Establishes a three-stage classification and the 10-year displacement threshold that drives current treatment recommendations.
A young patient with a "minimally symptomatic" scaphoid non-union is not a safe observation candidate if displacement is present. This paper is why we treat displaced non-unions regardless of symptoms: 100% of cases with radioscaphoid or generalized wrist arthritis had displacement and instability, and after 10 years even initially stable non-unions cross that threshold at a rate exceeding 88%.
In clinic, measure both the radiolunate angle and the scapholunate angle when assessing a chronic non-union. When degenerative change obscures the scaphoid, the lunate silhouette remains readable — a radiolunate angle ≥10° is your instability call.
For the truly asymptomatic patient with a confirmed undisplaced, stable non-union, surgery is not mandatory, but the conversation must include the near-certainty of late arthritic change. Fracture location and configuration add nothing to prognosis. Displacement and instability are the only radiographic variables that matter.