Hand and wrist fractures and nonunions

Fractures of the hand and wrist can be challenging injuries to treat. Distal radius fractures continue to be one of the most common musculoskeletal injuries seen by orthopaedic surgeons. Despite this, controversy exists regarding optimal treatment for these injuries. Surgical treatments range from closed reduction and pin fixation to open reduction and internal fixation. Volar locked plating continues to rise in popularity despite a lack of evidence demonstrating superior results over previous types of fixation. Certain carpal fractures remain challenging to detect and treat. If missed, these fractures can lead to morbidity. Scaphoid nonunion is such an example. Newer techniques including rib autograft and vascularized osteochondral grafts may be a viable alternative to salvage procedures.