Treatments for Scaphoid Nonunion

Scaphoid nonunions are still difficult to treat surgically. Free bone graft with Herbert type screw fixation used to be the gold standard for scaphoid nonunion in the 1990s, while union rate indicated below 80% normally. Several vascularized bone grafting techniques, such as the Zaidemberg technique, Bishop technique, or Makino technique were developed with satisfactory union rate, although mechanical strength of the grafted bone was unsatisfactory to keep the scaphoid length. As the scaphoid is a strut to keep the length and the alignment of the proximal carpal row, unstable scaphoid nonunion makes the distal scaphoid fragment flex while the others (proximal scaphoid, lunate, and triquetrum) extend, and the wrist can no longer keep its length, leading to the introduction of dorsal intercalated segment instability (DISI) deformity, i.e., carpal instability. Once DISI deformity occurs, progressive degenerative changes will be noted, which is known as the scaphoid nonunion advanced collapse. Also, blood supply of the scaphoid proximal side is quite unstable, and sometimes we see necrosis of the proximal pole after scaphoid waist or proximal fracture.

In this issue, a special symposium of “Treatments of Scaphoid Nonunion” has been organized by Dr P.C. Ho. He has invited Drs López and Wolfe for non-vascularized bone grafting, Dr Quadlbauer for palmar plate fixation, Dr Caloia for arthroscopic treatment without bone graft, Dr Koo for arthroscopic bone grafting, and Dr Higgins for vascularized bone grafting. Through this symposium, we understand the difficult treatment options for scaphoid nonunion and we can now learn from world experts in this field. I hope this symposium will help readers' selections in their daily practice.

From this issue, the Journal will start to publish e-issue papers. Since the coronavirus disease 2019 pandemic and the Journal acquiring its impact factor, submission numbers have increased along with the number of accepted papers. Therefore, publication period from the acceptance of a paper to publication in an issue extended between 2023 and 2025. To solve this problem, selected papers will be published as e-issue articles. There is no difference in the papers published in print and e-issue.

The issue also includes interesting wrist papers, such as carpal tunnel syndrome (CTS), distal radioulnar joint arthroplasty, failure of Universal 2 wrist prosthesis, arthroscopic scapholunate ligamentoplasty technique, and meta-analysis for nonunion of ulnar shortening. Do not miss them.

Publication History

Article published online:
21 January 2026