Home
Português
English தமிழ் Português 中文 Tiếng Việt Filipino ਪੰਜਾਬੀ Tradução automática — a versão em inglês é a versão oficial.

Fratura do Escafóide Folheto

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

Você provavelmente sentirá dor na base do polegar. Essa área é chamada de tabaqueira anatômica, que é a pequena depressão que você vê na parte dorsal da mão quando levanta o polegar. A dor geralmente começa após uma queda sobre a mão estendida. Pode parecer uma dor profunda ou uma ardência aguda. Você pode notar inchaço ao redor do punho e do polegar.

A dor geralmente piora quando você move o polegar ou o punho. Tarefas simples podem se tornar difíceis. Você pode ter dificuldade em segurar objetos com firmeza. Alcançar as costas para fechar um sutiã pode ser doloroso. Enfiar a camisa dentro da calça também pode causar desconforto. Virar uma maçaneta ou abrir um pote pode parecer desconfortável e doloroso. Você pode achar difícil levantar qualquer coisa mais pesada do que uma xícara de café.

Muitas pessoas notam que a dor piora à noite. Deitar-se do lado afetado pode pressionar a área lesionada e impedir que você durma. Você também pode sentir rigidez ao acordar pela manhã. Essa rigidez geralmente melhora após alguns minutos de movimento da mão. No entanto, usar a mão em excesso durante o dia pode fazer com que a dor reapareça.

É importante saber que algumas lesões não aparecem claramente nas radiografias iniciais. Se a dor persistir apesar de exames iniciais normais, não a ignore. Dor persistente nesse local específico é um sinal-chave de fratura do escafóide. O diagnóstico precoce ajuda a prevenir complicações a longo prazo. Seu cirurgião orientará sobre os próximos passos para garantir uma cicatrização adequada.

O que está realmente acontecendo

O seu pulso contém oito ossos pequenos que trabalham juntos como um sistema de engrenagens complexo. O escafóide é um desses ossos, localizado na base do seu polegar. Ele atua como uma ponte crítica, conectando o antebraço ao restante da mão. Essa posição permite que seu pulso dobre e gire suavemente.

Quando você cai sobre a mão estendida, esse osso pode rachar. Isso é chamado de fratura do escafóide. O escafóide tem um suprimento sanguíneo único que torna a cicatrização difícil. Se a fratura não cicatrizar adequadamente, é chamada de pseudartrose. Isso pode interromper o movimento delicado entre os ossos do carpo, causando dor e rigidez.

A maneira como os ossos se movem é fundamental para entender seus sintomas. Em um pulso saudável, as fileiras superior e inferior dos ossos do carpo se movem em um padrão coordenado. Um escafóide fraturado pode desacoplar essas fileiras. Isso significa que os ossos já não deslizam uns sobre os outros corretamente. Com o tempo, esse movimento anormal pode levar à osteoartrite por desgaste, conhecida como colapso avançado por pseudartrose do escafóide. Essa condição altera a forma da articulação e reduz a amplitude de movimento do seu pulso.

No entanto, nem todos os desfechos são graves. Muitos pacientes com fraturas do escafóide distal relatam função normal da mão e boa força anos depois. Mesmo que o osso cicatrize com uma leve deformidade, a função do pulso no médio prazo geralmente permanece inalterada. Praticamente todas as fraturas do escafóide consolidadas levam a um bom resultado, independentemente de um pequeno desalinhamento.

Seu cirurgião avaliará o deslocamento da fratura. Fraturas não desviadas podem cicatrizar bem com tratamento não operatório, como o uso de gesso. Fraturas desviadas frequentemente requerem fixação interna para manter o osso no lugar. A intervenção precoce é cada vez mais favorecida para prevenir complicações a longo prazo. O objetivo é restaurar o alinhamento natural dos ossos do seu pulso para que eles possam se mover juntos novamente sem dor.

O que podemos fazer a respeito

A abordagem do Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, adotada em nossa clínica reflete como gerenciamos essa lesão. Os pacientes chegam à nossa clínica por encaminhamento do clínico geral ou fisioterapeuta. Uma avaliação clínica (histórico, exame físico e exames de imagem quando necessários) estabelece o diagnóstico. Para problemas estruturais agudos, como uma fratura do escafóide, a cirurgia pode ser recomendada imediatamente, sem uma tentativa prévia de tratamento não operatório. No entanto, para fraturas não desviadas ou minimamente desviadas, frequentemente discutimos se o tratamento conservador é apropriado.

Você pode iniciar com automaneio e fisioterapia. Se a sua fratura for estável, podemos recomendar uma tala ou gesso para manter o osso imóvel enquanto ele cicatriza. A fisioterapia visa restaurar o movimento e a força do seu pulso após a consolidação óssea. Evidências mostram que, para fraturas não desviadas, o tratamento não operatório pode ser eficaz, com taxas de consolidação próximas ou superiores às da cirurgia. Você pode optar por esse caminho para evitar uma operação, embora isso exija paciência. A cicatrização pode levar tempo, e você deve manter a imobilização conforme orientado.

O manejo médico foca no alívio da dor e na proteção do osso em cicatrização. Geralmente, recomendamos analgésicos simples. Tenha cuidado com anti-inflamatórios (AINEs). Pacientes que utilizam esses medicamentos no primeiro mês após o diagnóstico têm maior risco de não consolidação e podem necessitar de procedimentos adicionais posteriormente. Evitamos prescrevê-los sempre que possível para dar ao seu osso a melhor chance de cicatrizar naturalmente. Injeções não fazem parte do tratamento padrão de fraturas agudas do escafóide, pois a prioridade é a estabilidade estrutural, e não o controle da inflamação.

A cirurgia é considerada quando o tratamento conservador não é adequado ou falhou. Recomendamos o tratamento operatório para fraturas desviadas, pois é improvável que essas cicatrizem corretamente sem estabilização. A fixação interna precoce é cada vez mais favorecida para pacientes selecionados, inclusive para algumas fraturas não desviadas, permitindo um retorno mais rápido ao trabalho. Para pseudoartroses que não consolidaram, podemos utilizar enxerto ósseo minimamente invasivo e parafusos de compressão. Este procedimento é seguro e eficaz para casos não complicados. Se você teve fraturas recentes que falharam a outros tratamentos, a ressecção distal do escafóide pode ser uma opção. Discutimos essas opções com você para decidir o que é mais adequado para o seu estilo de vida e objetivos de recuperação.

O que esperar

O seu pulso provavelmente ficará rígido e dolorido durante várias semanas. A maioria das pessoas nota que os sintomas diminuem gradualmente à medida que o osso cicatriza. Se tiver uma fratura do escafóide pediátrica, os resultados são geralmente excelentes. Nos adultos, o processo de cicatrização demora mais tempo. Pode notar que a dor aparece e desaparece à medida que começa a utilizar novamente a mão.

Se a sua fratura não estiver deslocada, poderá ser tratada com um gesso ou talco. Esta abordagem conservadora funciona bem para muitos pacientes. Não há benefício a longo prazo verdadeiro na cirurgia em comparação com o tratamento não operatório para este tipo de fraturas. O seu resultado funcional aos 12 meses é tipicamente o mesmo, quer tenha cirurgia ou não. No entanto, a cirurgia pode ajudar a retornar ao trabalho cerca de 7 semanas mais cedo.

Se a sua fratura estiver deslocada, o seu cirurgião provavelmente recomendará cirurgia. Isto envolve a colocação de um parafuso para manter as peças ósseas unidas. Esta abordagem ajuda o osso a unir-se de forma previsível. Mesmo que o osso cicatrize com uma forma ligeiramente diferente (união viciosa), o resultado é geralmente bom. A deformidade residual não impacta significativamente a função do pulso a médio prazo.

É importante compreender os riscos de não união, onde o osso falha em cicatrizar. A frequência de não união após o tratamento cirúrgico excede 10%. Se ocorrer não união, pode levar a alterações degenerativas progressivas no pulso. A não união persistente é comum após cirurgia para não união, e as cirurgias subsequentes têm menor sucesso. A apresentação tardia superior a 21 dias aumenta o risco de falha do tratamento com gesso.

A longo prazo, a maioria dos pacientes relata função normal da mão e boa força do pulso. De uma perspetiva de 8 a 11 anos, os pacientes com fraturas distais do escafóide relatam função autoavaliada da mão normal. Se a artrite se desenvolver devido à não união, a ressecção do escafóide distal é um procedimento duradouro. 94% dos pacientes permaneceram satisfeitos após este procedimento. Não ocorreu novo colapso do pulso nem artrite radiocarpiana após esta cirurgia.

A sua recuperação sente-se como um equilíbrio entre repouso e movimento suave. Seguirá um protocolo para proteger o osso em cicatrização, prevenindo ao mesmo tempo a rigidez. O seu cirurgião irá guiá-lo durante este processo. A maioria das fraturas unidas tem um bom resultado, independentemente de pequenos problemas de alinhamento.

Quando procurar ajuda médica

Consulte o seu médico de família se tiver dor persistente na base do polegar que não melhora com o repouso. Solicite uma avaliação especializada se notar fraqueza, instabilidade ou uma sensação de bloqueio no pulso. Procure cuidados de saúde urgentes se os sintomas interferirem no seu sono ou trabalho, ou se experimentar um agravamento súbito da dor. O diagnóstico precoce é fundamental, pois as radiografias padrão e os exames clínicos frequentemente não detetam estas lesões. Até 60% dos pacientes com uma verdadeira fratura podem não ser identificados inicialmente. O tratamento tardio pode levar à não união, onde o osso não cicatriza adequadamente. Isto pode exigir cirurgia e causar rigidez a longo prazo. Não ignore a dor no polegar após uma queda.

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series [2].
  • The clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases [15].
  • Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture [17].
  • The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully [14].
  • Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures [24].
  • This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • For all indications, the scaphoid staple has a high union rate and a low complication rate [6].
  • Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection [25].
  • Despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures [28].

Anatomy & Pathophysiology

  • The scaphoid is critical to the coordination of normal carpal kinematics [34].
  • Scaphoid fracture has significant biomechanical consequences to the wrist [34].
  • Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows [35].
  • Problem fractures and non-unions of the scaphoid are associated with major alterations in wrist kinematics [46].
  • Problem fractures and non-unions of the scaphoid are associated with a higher incidence of premature carpal collapse and degenerative arthritis than previously appreciated [46].
  • A foreshortened healed scaphoid will disrupt carpal kinematics [37].
  • A foreshortened healed scaphoid negatively impacts results, including decreased wrist range of motion and diminished grip strength [37].
  • Malunion or nonunion of an acute scaphoid fracture can lead to abnormal carpal kinematics and wrist arthrosis [61].
  • Radiocarpal-based lunate morphology was not associated with scaphoid fracture [74].
  • Anomalous carpal kinematics caused by lunotriquetral coalition may have predisposed both scaphoid bones to fracture, although causality cannot be proven [78].

Classification

  • Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series [2].
  • The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients [3].
  • If there is a strong clinical suspicion of a scaphoid fracture which cannot be confirmed by conventional radiology, bone scintigraphy is a valuable diagnostic tool [8].
  • The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures [9].
  • There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced' [10].
  • Due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance, 6-week radiographs are not adequate for evaluating suspected scaphoid fractures [12].
  • Scaphoid fractures account for 2% of all fractures and are the most commonly injured carpal bone [13].
  • There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies [41].
  • The authors hypothesise higher union rates in scaphoid fractures using more stable fixation systems [79].
  • Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data [80].

Clinical Presentation

  • Most scaphoid fractures are missed due to failure to consider the possibility of the injury and search for clinical signs [19].
  • 6-week radiographs are not adequate for evaluating suspected scaphoid fractures due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance [12].
  • Ultrasonic assessment is not recommended for the early diagnosis of acute scaphoid fractures, with a sensitivity of only 50% and five missed scaphoid fractures in a small series [39].
  • Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture [20].
  • The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries [23].
  • MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union [22].
  • The diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture [40].
  • Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage [16].

Investigations

  • Conventional radiographs combined with two clinical examinations provide inadequate diagnostic certainty for scaphoid fractures, identifying a true fracture in only about 40% of patients [3].
  • The combination of conventional radiographs and clinical reassessment does not increase diagnostic accuracy compared to conventional radiographs alone [9].
  • There is no consensus on the imaging modality or measurements used to define a scaphoid fracture as nondisplaced [10].
  • Six-week radiographs are not adequate for evaluating suspected scaphoid fractures due to low inter-observer agreement and poor diagnostic performance [12].
  • Most missed scaphoid fractures result from a failure to consider the injury possibility and search for clinical signs [19].
  • Clinical examination combined with early MRI scan should form the basis for diagnosing suspected scaphoid fractures [20].
  • MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion occurring in over 6% of cases despite appropriate initial immobilization [22].
  • Most patients with nonunion of MRI-detected scaphoid fractures require surgery to achieve union [22].
  • Early MRI in patients with clinically suspected scaphoid fractures accurately and reliably identifies a significant number of radiological occult injuries [23].
  • Early MRI in patients with clinically suspected scaphoid fractures allows for the early identification of patients without acute injuries [23].
  • Early MRI provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive [56].
  • Early MRI for suspected scaphoid fractures when initial radiographs are inconclusive is cost-effective and minimizes complications [56].
  • CT is a good way to screen for occult fractures but may not be superior to MRI or bone scanning in detecting scaphoid fractures without causing overtreatment [58].
  • Multidetector computed tomography (MDCT) has a sensitivity of 86% and specificity of 100% for detecting occult scaphoid fractures in patients with negative radiographic examinations [59].
  • MRI is the optimal second test for assessing a possible scaphoid fracture after a negative radiograph [60].
  • CT is preferred over MRI when the fracture is visible for further assessment and surgical planning [60].
  • There is variation in definitions of scaphoid fractures on MRI scans, highlighting a need for consensus to assess reliability and diagnostic performance [63].
  • Bone scintigraphy is inappropriate for evaluating specificity and sensitivity against clinical examination [64].
  • MRI is the recommended examination of choice for diagnosing occult scaphoid fractures over bone scintigraphy [64].
  • MRI is considered the best diagnostic radiological test for triage of suspected scaphoid fractures according to existing literature [67].
  • Bone scanning, CT, and ultrasound may be useful for suspected scaphoid fractures when MRI is not readily available [67].
  • Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment [72].
  • Nearly 70% of MRI findings in suspected scaphoid fractures are categorized as distracting and potentially misleading [72].
  • Stopping the pursuit of occult fractures may prevent unnecessary treatment due to the risk of overdiagnosis with routine MRI [72].
  • Better standardization of MRI definitions for scaphoid fractures is required to address diagnostic uncertainty [76].
  • A definitive definition may not exist to solve the potentially unsolvable issue of diagnostic uncertainty in scaphoid fractures [76].
  • Patients should participate in decisions regarding diagnostic and treatment strategies for scaphoid fractures due to diagnostic uncertainty [76].
  • MRI is not 100% specific for diagnosing occult scaphoid fractures, with a specificity of 96% in healthy volunteers [77].

Treatment

Nonoperative Management

  • Early treatment of acute scaphoid fractures is important, with union rates significantly greater when treatment is instituted prior to 4 weeks from injury [26].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks) [21].
  • We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [18].
  • Non- and minimally displaced scaphoid waist fractures are best treated conservatively [36].
  • Non-operative treatment of non-displaced scaphoid fractures may be preferred [53].
  • A restricted period of cast immobilisation is usually adequate for the treatment of non-displaced scaphoid fractures [53].
  • Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients to reduce the period of cast immobilization [57].
  • Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures [51].
  • Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures [54].

Operative Management

  • The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period [11].
  • The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective [44].
  • The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial [62].

Special Populations and Considerations

  • The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis [55].
  • This case is interesting as the child is one of the youngest patients described in the literature with a scaphoid fracture, and the fracture went on to non-union despite immediate medical attention and rigorous treatment [49].
  • The authors argue that comfort with uncertainty is key in suspected scaphoid fracture scenarios, as there is no best strategy; instead, clinicians should help patients choose a diagnostic and therapeutic course based on their individual values and risk tolerance [66].

Complications

  • Many decisions regarding scaphoid fracture management are based on small case series due to insufficient evidence for well-established principles [2].
  • Clinical outcomes of malunited scaphoids after reconstruction for scaphoid fracture nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • There is no true long-term benefit of internal fixation compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • The scaphoid staple has a high union rate and a low complication rate for all indications [6].
  • Subacute scaphoid fractures presenting within 6 months from injury can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed [7].
  • The frequency of nonunion after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period [11].
  • Appropriately performed acute percutaneous internal fixation is a standard treatment option for a selected group of patients with acute scaphoid fracture [17].
  • There is no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [18].
  • Persistent nonunion is common after surgery for scaphoid nonunion, and surgeries for persistent nonunion are even less successful [27].
  • Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure, although the union rate remains high with comparable time in cast [29].
  • Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but had overall good clinical results on midterm follow-up [30].
  • Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid [32].

Recovery

  • Clinical outcomes of malunited scaphoids after reconstruction for nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • The frequency of nonunion after surgical management for closed scaphoid fractures exceeds 10% [11].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years) [21].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures results in a significantly faster return to work (SMD of 7 weeks) [21].
  • Union rates are significantly greater when treatment is instituted prior to 4 weeks from injury [26].
  • Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful [27].
  • Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure [29].
  • The union rate remains high with comparable time in cast despite delayed presentation of scaphoid fractures 21 days or more after injury [29].
  • Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging [30].
  • Patients with malunited acute scaphoid fractures demonstrated overall good clinical results on midterm follow-up despite radiographic findings of early arthritis [30].
  • From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function [31].
  • From an 8- to 11-year perspective, patients with distal scaphoid fractures report good wrist motion and strength [31].
  • Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury [32].
  • Increased likelihood for nonunion was found when fracture volume was less than 38% of the entire scaphoid [32].
  • Patients treated nonoperatively or with salvage procedures had similar long-term outcomes as those treated with a corrective scaphoid osteotomy [65].
  • Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union [83].
  • Dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture viability assessment using contrast-enhanced MRI [84].
  • Scaphoid nonunions demonstrate findings indicative of progression to union on CT at a mean of 6 weeks [86].
  • Scaphoid nonunions demonstrate findings indicative of progression to union on CT as early as 3 weeks postoperatively [86].

Key Evidence

  • [L1] Pediatric scaphoid fractures have excellent outcomes. [1] (10.1177/1558944717735948)
  • [L5] Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series. [2] (10.1177/1753193420977241)
  • [L5] The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients. [3] (10.1097/corr.0000000000002413)
  • [L4] The clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. [4] (10.1016/j.otsr.2014.09.026)
  • [L1] This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. [5] (10.2106/jbjs.g.00673)
  • [L4] For all indications, the scaphoid staple has a high union rate and a low complication rate. [6] (10.1177/1558944716658747)
  • [Paper] If there is a strong clinical suspicion of a scaphoid fracture which cannot be confirmed by conventional radiology, bone scintigraphy is a valuable diagnostic tool. [8] (10.1016/j.injury.2005.02.009)
  • [L2] The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures. [9] (10.1097/corr.0000000000002310)
  • [L5] There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced.' [10] (10.1016/j.jhsa.2012.10.025)
  • [L3] The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period. [11] (10.1016/j.jhsa.2015.06.019)
  • [L2] Due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance, 6-week radiographs are not adequate for evaluating suspected scaphoid fractures. [12] (10.1007/s00402-016-2438-4)
  • [L5] Scaphoid fractures account for 2% of all fractures and are the most commonly injured carpal bone. [13] (10.1016/j.hcl.2017.04.003)
  • [L5] The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully. [14] (10.1142/s0218810415400018)
  • [L5] Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases. [15] (10.1016/s0749-0712(21)00118-9)
  • [L4] Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage. [16] (10.1016/j.injury.2009.07.078)
  • [L4] Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture. [17] (10.5435/00124635-200708000-00004)
  • [L1] We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. [18] (10.1302/0301-620x.104b8.bjj-2022-0085.r2)
  • [L4] Most scaphoid fractures were missed due to failure to consider the possibility of the injury and search for clinical signs. [19] (10.1016/j.injury.2019.05.009)
  • [L3] Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture. [20] (10.1177/1753193420979465)
  • [L1] Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks). [21] (10.1136/jisakos-2015-000024)
  • [L3] MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. [22] (10.1302/0301-620x.106b4.bjj-2023-1171.r1)
  • [L2] The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries. [23] (10.1177/1753193412471008)
  • [L1] Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures. [24] (10.2106/jbjs.rvw.15.00073)
  • [L4] Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection. [25] (10.1016/j.jhsg.2024.03.013)
  • [L5] Early treatment of acute scaphoid fractures is important, with union rates significantly greater when treatment is instituted prior to 4 weeks from injury. [26] (10.1016/s0749-0712(21)00580-1)
  • [L4] Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful. [27] (10.1016/j.jhsa.2015.06.022)
  • [L5] This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions, highlighting that despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures. [28] (10.1016/j.jhsa.2008.04.026)
  • [L4] Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast. [29] (10.1016/j.jhsa.2023.10.020)
  • [L4] Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but overall good clinical results on midterm follow-up. [30] (10.1016/j.jhsa.2020.04.002)
  • [L2] From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. [31] (10.1016/j.jhsa.2017.06.016)
  • [L5] The scaphoid is critical to the coordination of normal carpal kinematics, and its fracture has significant biomechanical consequences to the wrist. [34] (10.1016/s0749-0712(21)01439-6)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [35] (10.1016/j.jhsa.2008.03.008)
  • [L2] Non- and minimally displaced scaphoid waist fractures are best treated conservatively. [36] (10.1016/j.jhsa.2015.03.007)
  • [L5] All scaphoid fractures that heal do not yield acceptable results, as a foreshortened healed scaphoid will disrupt carpal kinematics and negatively impact results, including decreased wrist range of motion and diminished grip strength. [37] (10.1016/s0749-0712(21)01437-2)
  • [L4] With a sensitivity of only 50% and five missed scaphoid fractures in this small series, we can not recommend ultrasonic assessment for the early diagnosis of acute scaphoid fractures. [39] (10.1054/jhsb.2000.0432)
  • [L4] The diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture. [40] (10.1302/0301-620x.102b4.bjj-2019-0632.r3)
  • [L4] There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies. [41] (10.1177/1753193417739510)
  • [L4] The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective. [44] (10.1016/j.jhsa.2014.02.030)
  • [L5] Problem fractures and non-unions of the scaphoid are associated with major alterations in wrist kinematics and a higher incidence of premature carpal collapse and degenerative arthritis than previously appreciated. [46] (10.2106/00004623-199274030-00014)
  • [L4] This case is interesting as the child is one of the youngest patients described in the literature with a scaphoid fracture, and the fracture went on to non-union despite immediate medical attention and rigorous treatment. [49] (10.2106/00004623-198365080-00026)
  • [L1] Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures. [51] (10.1007/s11552-010-9276-6)
  • [L4] A restricted period of cast immobilisation is usually adequate for the treatment of non-displaced scaphoid fractures. [53] (10.1016/j.injury.2008.10.028)
  • [L2] Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures. [54] (10.1016/j.jhsg.2026.100958)
  • [L4] The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis. [55] (10.1016/s0749-0712(21)00181-5)
  • [L5] Early magnetic resonance imaging (MRI) provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive, which is cost-effective and minimizes complications. [56] (10.1016/j.jhsa.2013.03.055)
  • [L5] Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients to reduce the period of cast immobilization. [57] (10.5435/00124635-200007000-00003)
  • [Commentary] CT is a good way to screen occult fractures but may not be any better than MRI or bone scanning in detecting scaphoid fractures without some over treatment. [58] (10.1177/1753193412446273)
  • [L2] Although MRI remains the best diagnostic tool after radiography for detecting occult scaphoid fractures, MDCT sensitivity was 86% and specificity was 100% in this study. [59] (10.1007/s11604-010-0520-3)
  • [Paper] MRI is the optimal second test for assessing a possible scaphoid fracture after a negative radiograph, while CT is preferred when the fracture is visible for further assessment and surgical planning. [60] (10.1016/j.hcl.2019.03.001)
  • [L5] Early diagnosis and vigilant care of an acute scaphoid fracture are warranted to prevent malunion or nonunion, which can lead to abnormal carpal kinematics and wrist arthrosis. [61] (10.2106/00004623-200612000-00026)
  • [L4] The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. [62] (10.1177/15589447221093675)
  • [L3] This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits. [63] (10.1177/17531934251367541)
  • [L5] The authors argue that bone scintigraphy is inappropriate for evaluating specificity and sensitivity against clinical examination, and that MRI is the recommended examination of choice for diagnosing occult scaphoid fractures. [64] (10.1016/j.injury.2007.12.013)
  • [L4] Patients treated nonoperatively or with salvage procedures had similar long-term outcomes as those treated with a corrective scaphoid osteotomy. [65] (10.1177/1558944716643295)
  • [L5] The authors argue that comfort with uncertainty is key in suspected scaphoid fracture scenarios, as there is no best strategy; instead, clinicians should help patients choose a diagnostic and therapeutic course based on their individual values and risk tolerance. [66] (10.1097/corr.0000000000003141)
  • [L5] According to the existing literature, MRI is the best diagnostic radiological test for triage of suspected scaphoid fractures, but bone scanning, CT, and ultrasound may also be useful, particularly when MRI is not readily available. [67] (10.1016/j.jhsa.2008.04.016)
  • [L5] Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment, with nearly 70% of MRI findings categorized as distracting and potentially misleading, suggesting that stopping the pursuit of occult fractures may prevent unnecessary treatment. [72] (10.1097/corr.0000000000002914)
  • [L3] By contrast, radiocarpal-based lunate morphology was not associated with scaphoid fracture. [74] (10.1016/j.jhsa.2025.10.018)
  • [L5] The authors argue that better standardization of MRI definitions for scaphoid fractures is required, but acknowledge that a definition may not exist to solve the potentially unsolvable issue of diagnostic uncertainty, suggesting patients should participate in decisions regarding diagnostic and treatment strategies. [76] (10.1177/17531934251394819)
  • [Paper] MRI is not 100% specific for diagnosing an occult scaphoid fracture, with a specificity of 96% in healthy volunteers. [77] (10.1016/s0363-5023(10)60085-8)
  • [L4] The patient may represent two isolated coexisting conditions, or the anomalous carpal kinematics caused by the lunotriquetral coalition may have predisposed both scaphoid bones to fracture, although causality cannot be proven. [78] (10.1016/j.jhsa.2015.07.003)
  • [Paper] The authors hypothesise higher union rates in scaphoid fractures using more stable fixation systems. [79] (10.1007/s00402-016-2556-z)
  • [L5] Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data. [80] (10.1016/j.jhsg.2024.06.013)
  • [L3] Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union. [83] (10.1177/15589447221142894)
  • [L4] Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture. [84] (10.1007/s00256-014-1981-8)
  • [L4] Scaphoid nonunions demonstrate findings indicative of progression to union on CT at a mean of 6 weeks and as early as 3 weeks postoperatively. [86] (10.1016/j.jhsa.2016.07.051)

References

[1] Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis. HAND. 2017. DOI: 10.1177/1558944717735948

[2] Questions regarding the evidence guiding treatment of displaced scaphoid fractures. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420977241

[3] CORR Insights®: What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002413

[4] Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: A 5-year minimum follow-up study. Orthopaedics & Traumatology: Surgery & Research. 2015. DOI: 10.1016/j.otsr.2014.09.026

[5] Nonoperative Compared with Operative Treatment of Acute Scaphoid Fractures. The Journal of Bone & Joint Surgery. 2008. DOI: 10.2106/jbjs.g.00673

[6] The Scaphoid Staple: A Systematic Review. HAND. 2016. DOI: 10.1177/1558944716658747

[7] The Missed Scaphoid Fracture–Outcomes of Delayed Cast Treatment. Journal of Wrist Surgery. 2015. DOI: 10.1055/s-0035-1564983

[8] Outcome of routine bone scintigraphy in suspected scaphoid fractures. Injury. 2005. DOI: 10.1016/j.injury.2005.02.009

[9] What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002310

[10] Diagnosis of Scaphoid Fracture Displacement. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.025

[11] An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.019

[12] 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures. Archives of Orthopaedic and Trauma Surgery. 2016. DOI: 10.1007/s00402-016-2438-4

[13] Treatment of Scaphoid Fractures. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2017.04.003

[14] Scaphoid Fracture - Overview and Conservative Treatment. Hand Surgery. 2015. DOI: 10.1142/s0218810415400018

[15] INTERNAL FIXATION OF SCAPHOID FRACTURES. Hand Clinics. 1997. DOI: 10.1016/s0749-0712(21)00118-9

[16] Management of late-diagnosed scaphoid fractures. Injury. 2010. DOI: 10.1016/j.injury.2009.07.078

[17] Percutaneous Fixation of Scaphoid Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200708000-00004

[18] One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b8.bjj-2022-0085.r2

[19] Why scaphoid fractures are missed. A review of 52 medical negligence cases. Injury. 2019. DOI: 10.1016/j.injury.2019.05.009

[20] Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420979465

[21] Surgical treatment of non- and minimally-displaced acute scaphoid fractures favours over-conservative treatment but only in the short term: an updated meta-analysis. Journal of ISAKOS. 2016. DOI: 10.1136/jisakos-2015-000024

[22] The rate of nonunion in the MRI-detected occult scaphoid fracture. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b4.bjj-2023-1171.r1

[23] Early magnetic resonance imaging in patients with a clinically suspected scaphoid fracture may identify occult wrist injuries. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412471008

[24] Acute Scaphoid Fractures. JBJS Reviews. 2016. DOI: 10.2106/jbjs.rvw.15.00073

[25] Distal Scaphoid Excision for Chronic and Nonchronic Scaphoid Fracture Nonunion. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.013

[26] MANAGEMENT OF ACUTE SCAPHOID FRACTURES. Hand Clinics. 2000. DOI: 10.1016/s0749-0712(21)00580-1

[27] Importance of Computed Tomography in Determining Displacement of Scaphoid Fractures. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.022

[28] Treatment of Scaphoid Fractures and Nonunions. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.04.026

[29] Clinically Significant Treatment Delay in Pediatric Scaphoid Fractures. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.10.020

[30] Scaphoid Malunion Clinical and Radiographic Outcomes at a Minimum of 4 Years Follow-Up. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.04.002

[31] Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.016

[32] Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0039-3402769

[34] EFFECTS OF SCAPHOID FRACTURES ON THE BIOMECHANICS OF THE WRIST. Hand Clinics. 2001. DOI: 10.1016/s0749-0712(21)01439-6

[35] Interfragmentary Motion in Patients With Scaphoid Nonunion. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.03.008

[36] Conservative Treatment Versus Arthroscopic-Assisted Screw Fixation of Scaphoid Waist Fractures—A Randomized Trial With Minimum 4-Year Follow-Up. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.007

[37] INCIDENCE, MECHANISM, AND NATURAL HISTORY OF SCAPHOID FRACTURES. Hand Clinics. 2001. DOI: 10.1016/s0749-0712(21)01437-2

[39] Ultrasound for Diagnosis of Scaphoid Fractures. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0432

[40] The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b4.bjj-2019-0632.r3

[41] Scaphoid nonunion: what is the role of the Zaidemberg 1,2 intercompartmental supraretinacular arterial flap?. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417739510

[44] Scaphoid Nonunions Treated With 2 Headless Compression Screws and Bone Grafting. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.030

[46] Compression-staple fixation for fractures, non-unions, and delayed unions of the carpal scaphoid.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274030-00014

[49] Carpal scaphoid fracture and non-union in an eight-year-old child. Report of a case.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365080-00026

[51] Treatment of Acute Scaphoid Fractures: A Systematic Review and Meta-Analysis. HAND. 2010. DOI: 10.1007/s11552-010-9276-6

[53] Non-operative treatment of non-displaced scaphoid fractures may be preferred. Injury. 2009. DOI: 10.1016/j.injury.2008.10.028

[54] Early Nonsteroidal Anti-Inflammatory Drug Prescriptions and Nonunion After Scaphoid Fractures: A TriNetX Matched Cohort Study. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100958

[55] PERCUTANEOUS AND ARTHROSCOPIC SCREW FIXATION OF SCAPHOID FRACTURES IN THE ATHLETE. Hand Clinics. 1999. DOI: 10.1016/s0749-0712(21)00181-5

[56] The Role of Magnetic Resonance Imaging in Scaphoid Fractures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.055

[57] Acute Fractures of the Scaphoid. Journal of the American Academy of Orthopaedic Surgeons. 2000. DOI: 10.5435/00124635-200007000-00003

[58] Commentary on ‘Early CT for suspected occult scaphoid fractures’ by Stevenson et al. J Hand Surg Eur. 2012, 37: 447-51. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412446273

[59] Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations. Japanese Journal of Radiology. 2011. DOI: 10.1007/s11604-010-0520-3

[60] Imaging for Acute and Chronic Scaphoid Fractures. Hand Clinics. 2019. DOI: 10.1016/j.hcl.2019.03.001

[61] Acute Fractures of the Scaphoid. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/00004623-200612000-00026

[62] Postoperative Immobilization of Scaphoid Fractures: A Comprehensive Review of the Literature. HAND. 2022. DOI: 10.1177/15589447221093675

[63] Variation in definitions of scaphoid fracture on MRI scans for suspected fracture: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251367541

[64] A prospective comparison for suspected scaphoid fractures: Bone scintigraphy versus clinical outcome. Injury. 2008. DOI: 10.1016/j.injury.2007.12.013

[65] Long-Term Outcomes of Scaphoid Malunion. HAND. 2016. DOI: 10.1177/1558944716643295

[66] Reply to the Letter to the Editor: Routine MRI Among Patients With a Suspected Scaphoid Fracture Risks Overdiagnosis. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003141

[67] Imaging for Suspected Scaphoid Fracture. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.04.016

[72] Editor’s Spotlight/Take 5: Routine MRI Among Patients With a Suspected Scaphoid Fracture Risks Overdiagnosis. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002914

[74] The Association Between Lunate Morphology and Scaphoid Fractures: A Comparative Radiographic Assessment. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.10.018

[76] Re: van Boxel et al. Variation in definitions of scaphoid fracture on MRI scans for suspected fracture: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251394819

[77] False Positive MRI's for Scaphoid Fracture in Healthy Volunteers. The Journal of Hand Surgery. 2010. DOI: 10.1016/s0363-5023(10)60085-8

[78] A Rare Case of Bilateral Lunotriquetral Coalition and Bilateral Scaphoid Nonunion. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.003

[79] Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Archives of Orthopaedic and Trauma Surgery. 2016. DOI: 10.1007/s00402-016-2556-z

[80] Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon’s Practice and the Evidence. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.06.013

[83] Delayed Scaphoid Fracture Union in Patients With Comorbid Psychiatric Diagnoses: A Retrospective Analysis of 20 340 Patients. HAND. 2022. DOI: 10.1177/15589447221142894

[84] Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture. Skeletal Radiology. 2014. DOI: 10.1007/s00256-014-1981-8

[86] Early Detection of Healing of Scaphoid Fracture Nonunions Using Computed Tomography. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.051

AfiliaçõesO que isso significa? →