Radiographic evaluation of vascularity in scaphoid nonunions: A review

Abstract

Scaphoid fractures, particularly those that occur more proximally, are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone. Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole. Due to the tenuous blood supply of the scaphoid, it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies. Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid. Vascular compromise in the scaphoid presents a diagnostic challenge, in part due to the non-specific findings on plain radiographs and computed tomography. Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention. This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.

Keywords: Vascularity, Perfusion, Scaphoid fracture, Scaphoid nonunion, Scaphoid open reduction and internal fixation, Bone graft

Core Tip: This paper aims to summarize the modern radiographic methodologies available to clinicians to assess the vascularity of scaphoid nonunions, as it crucial in decision-making for future treatment plans. For example, a scaphoid nonunion with preserved vascularity at the proximal pole may be amenable to simple bone grafting and open reduction internal fixation. In cases with compromised perfusion, significantly more extensive surgical intervention involving vascularized bone transfer may be required. Given the drastic differences in treatment algorithms, review papers such as this are needed to better educate the medical community to improve treatment of this complex orthopedic disease process.