Scaphoid Nonunion Advanced Collapse: A Review

Scaphoid fracture nonunion leads to altered wrist biomechanics for patients and can result in degenerative arthritis of the wrist and debilitating pain with loss of motion.  Watson and Ballet first quantified and qualified this pattern of arthritis in 1984 which is akin to the advanced collapse pattern seen in scahpolunate ligament disruption.  Treatment begins conservatively however may require surgical intervention for those who continue to loss motion, function, and have pain.  There is much debate on the optimal surgical procedure however the two predominant procedures of four corner fusion and proximal row carpectomy have been studied extensively for efficacy.  Each surgery has its merits with the goal of relieving pain while leaving maximal function and motion.