Scaphoid Nonunions

This chapter presents a case scenario of a 39-year-old male who presents with progressive wrist pain, possibly following a wrist sprain sustained 1.5 years ago, for which he did not seek medical attention. Identification of risk factors associated with scaphoid nonunion contributes to the prevention, diagnosis, and tailored treatment in at risk patients. Fracture location and displacement are considered important determinants for fracture union. The aim of treating scaphoid nonunion includes union, the relief of symptoms, as well as the limitation of degenerative wrist arthritis, known as the scaphoid nonunion advanced collapse (SNAC) wrist. Proximal row carpectomy and four-corner arthrodesis are salvage procedures for stage II-III SNAC wrists. Delayed treatment, use of opioids or nonsteroidal anti-inflammatory drugs, and smoking increase chances of nonunion and reduce chances of successful nonunion surgery. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.