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Glucocorticoid Use Is Associated with Increased Risk of Nonunion and Postoperative Complications Following Scaphoid ORIF: A Retrospective Cohort Study
Philong Nguyen, BS
1, Joshua Wang, MS
1, Evan S Pistone, BBA
1, Yousef Tanas, MD
2; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX
Introduction: Glucocorticoids are widely prescribed for chronic inflammatory and autoimmune conditions but are known to impair bone healing and immune response. While their adverse effects have been documented in major orthopedic procedures, their influence on outcomes following open reduction and internal fixation (ORIF) of scaphoid fractures remains poorly defined. This study evaluates the impact of preoperative glucocorticoid use on postoperative complications following scaphoid ORIF.
Methods: Using the TriNetX Research database, adults (?18 years) who underwent scaphoid ORIF between 2016 and 2023 were identified and stratified based on documented systemic glucocorticoid use prior to surgery. Propensity score matching was performed to control demographics and comorbidities. Primary outcomes included nonunion, malunion, revision surgery, wound complications, infection, thromboembolic events, postoperative stiffness, and complex regional pain syndrome (CRPS). Risk ratios and 95% confidence intervals were assessed for 90 days and 2 years per outcome postoperatively. Statistical significance was defined as p < 0.05.
Results: At 90 days, glucocorticoid users experienced significantly higher rates of infection (RR: 1.93; 95% CI: 1.02-3.66; p = 0.040), stiffness (RR: 1.53; 95% CI: 1.20-1.95; p = 0.001), and CRPS or persistent hand/finger pain (RR: 1.52; 95% CI: 1.10-2.09; p = 0.010). No significant differences were observed in wound disruption (p = 0.826), sepsis (p = 1.000), deep vein thrombosis (p = 0.962), or pulmonary embolism (RR not available; p = 0.001). Revision surgery within 90 days was also not significantly different (p = 0.412). At 2 years, glucocorticoid use was associated with significantly increased risks of nonunion (RR: 1.31; 95% CI: 1.08-1.58; p = 0.005) and revision surgery (RR: 3.73; 95% CI: 1.93-7.22; p < 0.0001). Malunion was more frequent but did not reach statistical significance (RR: 1.90; 95% CI: 0.89-4.07; p = 0.093).
Conclusion: Systemic glucocorticoid use is associated with increased risks of infection, stiffness, and CRPS within 90 days, as well as significantly higher rates of nonunion and revision surgery at 2 years following scaphoid ORIF. These findings suggest glucocorticoid exposure may impair bone healing and increase susceptibility to complications. Careful risk stratification and perioperative planning are recommended for glucocorticoid-dependent patients undergoing scaphoid fixation.
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