Displaced fractures of the scaphoid.

The scaphoid is the most commonly fractured carpal bone. The displaced fracture poses a particular surgical problem. While scaphoid fractures as a group show a 90%-95% union rate, those fractures with greater than 1 mm of displacement are associated with a 55% incidence of nonunion and a 50% rate of avascular necrosis. Displaced fractures that unite spontaneously do so only after prolonged immobilization and are associated with a greater incidence of painful malunion. Displaced scaphoid fractures that result in malunion or nonunion are more prone to develop late carpal osteoarthritis. The higher incidence of complications with the displaced scaphoid fracture suggests that an anatomic reduction is essential. If closed manipulation is unsuccessful, open reduction and internal fixation are indicated.