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The management of scaphoid nonunion, although relatively common, continues to pose challenges, especially if complicated by avascular necrosis of the proximal pole, humpback or dorsal intercalated segment instability deformities, and early scaphoid nonunion advanced collapse. In this round table article, four surgeons were asked to answer key questions on a clinical example of a proximal scaphoid nonunion to outline their approach and rationale in their preferred treatment choices. The current panel of experts leans towards arthroscopic methods of treatment and most agree that arthroscopic bone grafting has become an important and revolutionary treatment option, which has yielded excellent results. However, both open and arthroscopic grafting are validated methods of treatment and which is to be performed is largely based on the surgeon's preference.
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http://dx.doi.org/10.1177/17531934241289256 | DOI Listing |
JBJS Essent Surg Tech
August 2025
Duke University Medical Center, Durham, North Carolina.
Background: Scaphoid fractures are a common, yet challenging, injury to treat. The mini-open dorsal approach to the scaphoid is a simple, yet effective, approach that allows for improved visualization and more accurate screw placement in the setting of scaphoid fracture fixation.
Description: An approximately 2-cm longitudinal incision is made centered over the dorsal radiocarpal joint, just ulnar to the Lister tubercle.
J Hand Surg Am
August 2025
Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA. Electronic address:
Purpose: Scaphoid nonunion management is controversial and is dependent upon many factors without a clear algorithm. Traditionally, open approaches involved corticocancellous, vascularized, or nonvascularized structural bone grafting with internal fixation. Recent arthroscopic techniques have improved the ability to assess the stability of fractures and the need for bone grafting while preserving blood supply.
View Article and Find Full Text PDFTech Hand Up Extrem Surg
August 2025
Hand and Upper Extremity Surgery, Florida Orthopaedic Institute, Temple Terrace.
Four-corner fusion is a reliable surgical option for symptomatic scapholunate advanced collapse and scaphoid nonunion advanced collapse. There are multiple current techniques with potential complications, including nonunion, hardware failure, impingement, and cartilage disruption. Despite these potential complications, 4-corner fusion can result in good functional outcomes and patient satisfaction.
View Article and Find Full Text PDFJ Hand Surg Glob Online
September 2025
Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA.
Purpose: Wrist arthritis because of scaphoid nonunion advanced collapseand scapholunate advanced collapse can be treated through scaphoid excision and four-corner arthrodesis. There are many fixation techniques; however, there are few studies reporting outcomes in which only Nitinol staples were used. This study aimed to evaluate whether patients undergoing a four-corner arthrodesis using this fixation technique as well as intraoperative modifications to minimize complications will have successful outcomes.
View Article and Find Full Text PDFJ Hand Surg Eur Vol
August 2025
Hand Surgeon, private practice, Spain.
Wrist arthroscopy is a valuable tool in hand surgery. However, as with every tool, its use must be executed by the right hands with the right training and right instrumentation. In this article, four papers on arthroscopy were examined for their contribution to the literature and to reflect on the evolving role of arthroscopy in hand surgery.
View Article and Find Full Text PDF