Surgery for Scaphoid Nonunion with Humpback deformity

June 1st, 2007

Scaphoid nonunion may result in a so-called "hump back" deformity when the scaphoif flexes at the nonunion, and carpal collapse develops. If union is the only yardstick by which outcome is assessed, your scaphoid may heal--but you may not regain adequate wrist extension and you may be at risk down the road for arthritis.

Accordingly, I will carefully assess your xray when you visit the office. If you have a DISI deformity (extended lunate bone), and a scaphoid nonunion, you may require a structural bone graft and screw--so that the scaphoid deformity is corrected. Indeed, long-term outcome is going to be most ideal if your scaphoid heals without a persistent hump back deformity. This will be critical to restoring wrist extension, which is generally lost when a hump back deformity is present because of the associated carpal collapse.

Related Photos:

Preoperative PA shows scaphoid nonunion, and suggests forshortening as well

Preoperative lateral xray shows DISI deformity, thus there is a humpback deformity

Wedge- shaped bone graft is inserted and stabilized with a headless screw. Nowadays the use of cancellous graft as opposed to iliac crest is an option as well

Postoperative PA xray after union

Postoperative lateral xray shows that the DISI has been corrected, which is critical to the restoration of wrist extension

Wrist flexion

Wrist extension

Radial deviation

Ulnar deviation