Fractures and non-unions of the carpal scaphoid.

In the past ten to fifteen years, investigators have demonstrated conclusively that some injuries about the wrist have profound long-term consequences relative to function of the wrist. Problem fractures and non-unions of the scaphoid have been associated, in particular~ with major alterations in the kinematics of the wrist8’64. Considering its vulnerable blood supply~-4, irregular shape, peculiar oblique alignment across the plane of motion of the mid-carpal joint, and complex function as a link between the proximal and distal carpal rows2t, it is not surprising that the carpal scaphoid presents a number of diverse challenges to clinicians seeking optimum methods of treating such fractures. Despite previous reports of rates of union that exceeded 95 per cent after the wrist was treated with simple immobilization in a cast lO.t 1,~3.14,18,38,40.41,48,53, recent studies of scaphoid fractures