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Trends in Nonvascularized Bone Grafting for Nonunion of the Scaphoid
Ram K. Alluri, MD; Jeffrey R. Hill, BS; Pannell, MD; Anthony D'oro, BS; Jeffrey Wang, MD; Alidad Ghiassi, MD
University of Southern California, Los Angeles, CA
Introduction: The scaphoid is the most commonly fractured carpal bone and due to its retrograde blood supply it is predisposed to nonunion. The purpose of this study was to assess the incidence and demographic trends of scaphoid fractures, scaphoid nonunion, and nonvascularized bone grafting (NVBG).
Methods: The PearlDiver Patient Records Database was queried using Current Procedural Terminology (CPT) and International Statistical Classification of Diseases and Related Health Problems-9 (ICD-9) codes to identify patients diagnosed with scaphoid fractures and nonunions subsequently treated with NVBG from 2007 to 2015. Ninety-day complications after NVBG were also analyzed. In order to control for increases in the denominator of the PearlDiver Patient Records Database, the reported values were normalized and reported as incidence per 1 million persons searched. Categorical variables were compared using the chi-square test and incidences were analyzed using a generalized linear model.
Results: The overall incidence of scaphoid fractures was 575, the incidence of scaphoid nonunion was 36 (6.3%) and those treated with NVBG was 16 (44% of scaphoid nonunions) per 1,000,000 patients searched. There was an increasing annual linear trend in the diagnosis of scaphoid fractures (P< 0.05), but the incidence of scaphoid nonunion and NVBG did not increase between 2007 to 2015 (P>0.05). Forty-seven percent of patients diagnosed with a scaphoid fracture were male (P>0.05). Seventy-six percent of patients diagnosed with a scaphoid nonunion were male (P<0.05) and 81% of patients who underwent NVBG were male (P<0.05); however, NVBG rates for scaphoid nonunion were similar between males and females when controlling for incidence (32% and 26%, respectively). Forty-nine percent of patients diagnosed with a scaphoid fracture were less than 25 years of age (P<0.05); 60% of scaphoid nonunions were in patients less than 25 (P<0.05), and 80% of NVBG occurred in patients less than 25 (P<0.05). The overall complication rate of NVBG was 12.9%.
Conclusion: Scaphoid fractures continue to occur in approximately 1% of the population and the overall incidence is rising. Among all scaphoid fractures, nonunions tend to occur in 6% of patients and nearly half of these will be treated with NVBG. Male patients with scaphoid fractures are more likely to be diagnosed with a nonunion; however, both males and females diagnosed with a scaphoid nonunion are equally likely to be treated with NVBG. Patients aged less than 25-years-old diagnosed with a scaphoid nonunion are more likely to be treated with NVBG.
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