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Outcomes after Treatment of Scaphoid Nonunion with Open Reduction Internal Fixation and Corticocancellous vs Cancellous Only Nonvascularized Autograft
Lynn Ann Forrester, MD
1, Rafa Rahman, MD, MPH
1, Raylin Xu, MD
1, Michelle Carlson, MD
1, Daniel A Osei, MD
1; Samir K. Trehan, MD
2(1)Hospital for Special Surgery, New York, NY, (2)Orthopedic Surgery, Hospital for Special Surgery, New York, NY
Introduction
The use of vascularized vs nonvascularized bone graft in the treatment of scaphoid nonunions has been studied extensively, but relatively little comparison of outcomes after treatment with various forms of nonvascularized autograft has been performed. The purpose of this study was to assess outcomes after treatment of scaphoid nonunion with open reduction internal fixation and corticocancellous versus cancellous only nonvascularized autograft.
Materials & Methods
This was a retrospective case series assessing all patients with scaphoid nonunions treated with open reduction internal fixation (ORIF) and nonvascularized autograft at a multispecialty orthopedic hospital by 10 hand fellowship trained orthopedic surgeons from 2014-2024. Inclusion criteria were 12 weeks or greater from date of injury to date of surgery. Exclusion criteria were an absence of postoperative documentation or imaging. Radiographic healing was defined as 50% bridging bone on CT scan.
Results
Sixty-four patients, 25 treated with cancellous only (COA) and 39 treated with corticocancellous autograft (CCA), were included in this study. Mean patient age was 25 years old. Ninety percent of all patients exhibited radiographic healing. 7 patients did not heal or were lost to follow up. By 6 months postop, 84% of patients were healed. Median time to healing for all patients was 83 days (mean 100 days). Ninety percent of patients treated with CCA and 72% of patients treated with COA healed by 6 months postop, but there was no significant difference in likelihood of healing between the two groups (p>0.05). Patients treated with CCA had significantly greater time from injury to surgery (738 vs 270 days, p=0.04), yet exhibited radiographic healing significantly earlier (85 vs 126 days, p=0.038), than patients treated with COA. In addition to nonunion, complications included 2 patients treated with COA exhibited complete radiographic healing, and then later experienced a refracture of the scaphoid.
Conclusions
This study demonstrates that patients with scaphoid nonunions, including those with a prolonged period between injury and surgical treatment, can be reasonably managed with ORIF and nonvascularized autograft. While there was no significant difference in likelihood of healing between those treated with CCA and COA, this study will help hand surgeons counsel patients regarding expected time to healing after surgery, and can guide timing of postoperative CT scans.
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