Scaphoid nonunion and SNAC treatment

Introduction Scaphoid nonunion can result in progressive scaphoid nonunion advanced collapse (SNAC) and  have an impact on the quality of life in younger patients. The social significance of the pathological condition induces original research and literature analysis.The objective was to identify methods for preventing scaphoid nonunion and improving treatment outcomes for SNAC patients based on the literature on etiology, diagnosis and treatment of the disease.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org) and using the  keywords: scaphoid nonunion, scaphoid, bone grafting, scaphoid nonunion, vascularized bone graft. The  search yielded 355 results. Literature searches included both Russian and English studies published between 1984 and 2024. Inclusion criteria included original articles, systematic reviews, meta-analyses relevant to the search topic. Non-inclusion criteria included a case report, case/control, and articles available only on a fee-paying basis. There were 67 articles identified.Results and discussion The topography of the scaphoid is associated with a high incidence of avascular necrosis, delayed healing and fracture nonunion. Clinical testing and imaging are essential for diagnosis of scaphoid fractures in the acute period of injury, and fracture instability would be important for surgical indications. There is a classification of scaphoid nonunions that is practical for the choice of a surgical treatment (osteosynthesis with compression screws, debridement and bone grafts or “salvage” operations). Scaphoid nonunions treated with the Ilizarov method employing no open approaches or grafts was reported in  a few publications. Treatment of SNAC patients is traditionally based on the stage of the disease: 1 —  scaphoid reconstruction, resection of the styloid process of the radius; 2–3 — 4-corner arthrodesis or the proximal row carpectomy. Meta-analyses highlight the need for the research into the effectiveness of  various treatments. Arthroscopic techniques are common in wrist surgery improving diagnostic capabilities and minimally invasive interventions.Conclusion Timely healing of a scaphoid fracture is essential for preventing carpal instability and SNAC. The choice of SNAC treatment is associated with the stage of the disease and functional needs of the patient.