Scaphoid bone fractures and pseudarthrosis

Scaphoid fractures are common injuries and occur in approximately 80% of carpal bone fractures. If a fracture of the scaphoid is clinically suspected precise radiological diagnostics are mandatory. A primary computed tomography (CT) scan can be used to detect occult fractures and to subdivide fractures according to the classification of Krimmer/Herbert. A conservative or surgical approach is indicated depending on the type of fracture. Conservative treatment is possible for all stable fractures of the scaphoid bone but all unstable fractures need to be treated operatively. In cases where healing is impaired and nonunion occurs arthrosis of the wrist may follow. Conventional non-vascularized bone grafts are usually the treatment of choice for reconstruction of the shape and length of the scaphoid bone but are less suitable in cases of previously failed operations or avascular necrosis of the proximal pole. Further therapy options are pedicled bone grafts and free vascularized bone grafts.