Scaphoid nonunion treated by open reduction, anterior inlay bone grafting, and Kirschner-wire fixation.

Forty-three patients with ununited fractures of the scaphoid were treated by open reduction, anterior inlay bone grafting and Kirschner wire fixation. All but one achieved bone union. The one failure was successfully treated with a second anterior inlay bone grafting procedure. The average period of cast immobilization was 7 weeks. The presence of an unstable nonunion did not adversely affect the results. In cases with carpal instability, we used a longer corticocancellous graft to restore a more normal alignment of the scaphoid by opening up the volar cortex. Preoperatively, carpal instability was present in 25 patients. In these cases, carpal alignment demonstrated by the radiolunate and scapholunate angle was improved significantly after surgery: the radiolunate angle from 15 degrees before surgery to 2 degrees after surgery, and the scapholunate angle from 67 degrees to 54 degrees, respectively. Pain, restricted motion of the wrist, and the grip strength were improved after surgery.