Our Treatment Strategy for Scaphoid Nonunion

In our practice for scaphoid waist nonunion, our preferred method is arthroscopic bone grafting with percutaneous headless screw fixation using cancellous bone graft from the ipsilateral distal radius. According to surgeon preferences, lateral approach open grafting with headless screw fixation is often used as well. Union rate above 90% has been recorded. In revision cases, we consider modified Russe technique or volar approach using structural ASIS tricortical graft with mini-plate fixation. In cases of proximal pole fracture with or without avascular necrosis, our treatment options include vascular bone graft from volar carpal artery branch or 1,2 ICSRA, or arthroscopic bone grafting combined with SL fixation. In cases with non-salvageable proximal pole avascular necrosis, we have tried free medial femoral trochlear flap and rib osteochondral graft reconstruction. Both have achieved satisfactory results but our experience is limited.