Scaphoid Nonunions

Scaphoid nonunions are challenging injuries to manage and the optimal treatment algorithm continues to be debated. Most scaphoid fractures heal when appropriately treated; however, when nonunions occur, they require acute treatment to prevent future complications like scaphoid nonunion advanced collapse. Acute nonunion treatment technique depends on nonunion location, vascular status of the proximal pole, fracture malalignment, and pre-existing evidence of arthrosis. Bone grafting and vascular grafts are common in nonunion management. Chronic nonunions that have progressed to scaphoid nonunion advanced collapse often require a salvage procedure such as four corner fusions, proximal row carpectomy, or wrist fusion. Herein, we review the current literature regarding scaphoid nonunions with regards to their anatomy, natural history, classification, diagnostic imaging, surgical management, and clinical outcomes.