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Current Trends in Operative Techniques for Scaphoid Non-union: A Survey of Hand Surgeons
David J. Byun, MD; Nikunj N. Trivedi, MD; Scott W. Wolfe, MD; Steve K. Lee, MD
Hospital for Special Surgery, New York, NY

Purpose: With the number of procedures available for the surgeon, surgical treatment of scaphoid non-union remains varied and controversial. The purpose of this study was to collate current trends in operative techniques used by hand surgeons for the treatment of scaphoid nonunion.
Methods: Members of the ASSH were surveyed via email. We created a set of 6 multiple choice questions regarding their treatment preferences in scaphoid nonunion procedures. We asked how long surgeons have been practicing, surgical approach, assessment scaphoid vascularity, bone graft preferences, fixation methods, and additional modalities used. Statistical analysis of surgical preferences was presented as frequency- adjusted mean standard error with differences between groups calculated using t-test and chi-square test. The level of significance was = 0.05 for all tests.
Results: Of the 1681 active members of ASSH, 315 responses were received (18.7% response rate). Regarding surgical approach, open palmar was most common at 58% followed by open dorsal at 34%. 7% used percutaneous and less than 1% arthroscopic. For vascularity assessment, 78% use MRI, 67% intraoperative bleeding, 47% radiographs, 16% CT, 2% histology. For bone graft, 50% use distal radius non-vascularized, 23% use iliac crest non-vascularized, 18% 1,2 SRA, <1% medial femoral condyle, 8% other (volar carpal artery, capsular based, olecranon). Headless compression screws were the most common bone fixation method at 78%, followed by K wires in scaphoid only at 10%, screw plus K wires 9%, plate 1.3%. Additional modalities used to augment healing were electrical stimulation 40%, ultrasound 35%.
Conclusions: As expected, there is a wide range of treatment preferences for scaphoid nonunion. Progression in novel techniques reported in the literature as well as evolution in surgical training may in part help explain the varying preferences for scaphoid non-union techniques. Future studies will aim to assess the effect on outcome based on the differing preferences for treating scaphoid non-union.

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