JHS - 2026-06-08 - Journal Article
Outcomes After Treatment of Scaphoid Nonunion With Open Reduction Internal Fixation and Nonvascularized Autograft.
Forrester LA, Rahman R, Xu R, Carlson M, Osei D, Trehan SK
Topics
Key Takeaway
Open reduction internal fixation with nonvascularized autograft achieved 95% union rate for scaphoid nonunion, with no difference in outcomes between corticocancellous and cancellous-only graft.
Summary Depth
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Summary
This retrospective case series evaluated 99 patients with scaphoid nonunions (≥12 weeks from injury) treated with ORIF and nonvascularized autograft at a single multispecialty center from 2014–2024. Overall union rate was 95% with median time to healing of 81 days; 89% demonstrated bridging bone on first CT at median 77 days, of whom 99% achieved union. No significant difference in union rate or time to healing was found between corticocancellous autograft (n=52) and cancellous-only autograft (n=45).
Key Limitation
Retrospective design with no functional outcome scores (DASH, PRWE) or grip strength data limits assessment of clinical recovery beyond radiographic union.
Original Abstract
PURPOSE
The purpose of this study was to assess outcomes after treatment of scaphoid nonunion with open reduction internal fixation and nonvascularized autograft (NVA).
METHODS
This was a retrospective case series assessing all patients with scaphoid nonunions treated with open reduction internal fixation and NVA at a multispecialty orthopedic hospital from 2014 to 2024. Inclusion criteria were 12 weeks or greater from date of injury to date of surgery. Exclusion criteria were absence of postoperative CT scan or presence of additional local procedures. Radiographic healing was defined as 50% bridging bone on CT scan.
RESULTS
Ninety-nine patients were included in this study: 45 patients were treated with cancellous only autograft (COA), 52 were treated with corticocancellous autograft (CCA), and 2 were treated with osteochondral autograft. Ninety-five percent of patients healed. Median time to healing was 81 days. On first postoperative CT, obtained at a median of 77 days after surgery, 75% of patients were healed. Eighty-nine percent of patients had bridging bone present on first CT; 99% of these patients went on to heal. Thirteen patients in this study had a prior attempt at surgical fixation at another institution; all healed after revision surgery. There were no significant differences in the odds of healing at any time point or the time to healing for patients treated with CCA versus COA.
CONCLUSIONS
Surgical treatment of scaphoid nonunion with NVA had a union rate of 95%. There were no significant differences in outcomes between patients treated with CCA and COA. Of patients who exhibited bridging bone on CT obtained at a median of 76 days after surgery, 99% went on to union. These findings support use of NVA for scaphoid nonunion and discourage the use of multiple postoperative CT scans to confirm healing.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.