The indications and methods of treatment for nonunion of the carpal navicular remain varied and controversial. Ninety-eight patients were seen because of symptoms due to a persistent nonunion. Of these, only 27 were sufficiently disabled to require reconstructive surgery: 13 with nonunion of waist fractures and mild radiocarpal degenerative changes underwent bone grafting and radial styloidectomy (ten had good results); seven with nonunion of the proximal third fractures and minimal degenerative changes were treated by bone grafting or excision of the fragment (depending on vascular status) and radial styloidectomy (four had good results, one poor); three with stable fibrous unions but having symptoms due to generative changes were successfully relieved by radial styloidectomy, and four patients required wrist fusion because of severe degenerative changes and pain.
Bruce Sprague, E. Jeff Justis. Nonunion of the Carpal NavicularModes of Treatment. Arch Surg. 1974;108(5):692–697. doi:10.1001/archsurg.1974.01350290056009