27yo male who suffered e fracture scaphoid 7 yago.

27yo male who suffered e fracture scaphoid 7 yago.

Dear colleagues , i would like to present a case of a 27 yo male who suffered a fracture scaphoid 7 years ago. He was treated with volar ORIF , and bone graft . he then was told he had a non union but warned against revision surgery. He has put up with the wrist pain for as long as he could and has been sent on for possible management to me.

I see that the screw has migrated into the wrist joint and created a large grove in the scaphoid fossa . and persistent non union.

He has pain centred over the radial side of the wrist and gets obvious jabs of pain with wrist movement in unpredictable loading generally will not move wrist beyond 30 degrees of flex and extension

? options. 
I have considred redrafting and short screw ?
what to do with the defect in radial surface ?
i was also considering a APSI and if unstable intraoperatively then move to a 4-corner fusion

thank you

ANGELO RANDO (Australia)


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