An ununited scaphoid fracture whose proximal fragment is small,
sclerotic, fragmented, or badly deformed is usually not suitable for
bone-grafting. We treated twenty-one such patients by excision of the small
proximal fragment through a volar incision and the insertion of a
hand-carved silicone-rubber spacer. After surgery, twenty patients (95 per
cent) were able to return to work and engage in strenuous activities,
including sports. Pain was significantly relieved, although wrist motions
and grip were only minimally improved. Preoperative and postoperative
comparative measurements of carpal collapse and translation showed only
insignificant changes after this procedure.