Review Question - QID 788

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Scaphoid Fracture Nonunion Treatment Operative QID: 788 (OBQ07.127)

QID 788 (Type "788" in App Search)

A 20-year-old skateboarder fell 6 months ago and has had radial-sided wrist pain since. His radiograph upon presentation to your office is shown in figure A. What is the most appropriate treatment at this time?

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four corner fusion

75/4555

long arm thumb spica cast

52/4555

wrist arthroscopy to evaluate intercarpal ligaments

60/4555

open reduction internal fixation with autologous bone graft

95%

4328/4555

wrist arthrodesis

13/4555

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This patient has a scaphoid waist fracture nonunion. Several studies indicate that scaphoid nonunions left untreated have a determined course of collapse and progressive arthritis (scaphoid nonunion advanced collapse - SNAC). Per Markiewitz et al, the standard treatment of scaphoid nonunions is open reduction internal fixation with bone graft; non-operative treatment is not appropriate. Proximal row carpectomy and wrist fusion are salvage procedures reserved for patient that has an advanced scaphoid nonunion, collapse and wrist arthritis.