Journal of Pediatric Orthopaedics - 2026-07-13 - Journal Article
Outcomes of Distal Radius Autograft in Adolescent Scaphoid Nonunion Repair.
Rupp GE, Rea PM, Curran PF, Bomar JD, Edmonds EW, Wallace CD
Topics
Key Takeaway
ORIF with distal radius cancellous autograft achieved 100% union in adolescent scaphoid nonunion at a mean of 3.3 months, with 94% returning to activities by 9.6 months.
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Summary
This study evaluated radiographic outcomes and predictors of time to union in adolescent scaphoid nonunions treated with ORIF and distal radius cancellous autograft at a single center from 2010–2021. All 35 wrists achieved union at a mean of 3.3 months; scapholunate angle improved from 62.5° to 52.5° and radiolunate angle from 17.8° to 9.7° (both P<0.001). Ninety-four percent of patients returned to activities at a mean of 9.6 months postoperatively with no intraoperative complications.
Key Limitation
Single-center retrospective design with no control group and no functional outcome scores prevents comparison to alternative grafting techniques (e.g., iliac crest, vascularized graft) or assessment of patient-reported outcomes.
Original Abstract
BACKGROUND
When treated early with cast immobilization, adolescent scaphoid fractures have excellent outcomes; however, nonunion may occur, particularly in patients with a delayed presentation. The purpose of this study is to evaluate the radiographic outcomes and to determine factors associated with time till union in adolescent scaphoid fracture nonunions treated with open reduction and internal fixation (ORIF) with distal radius cancellous autograft interposition.
METHODS
Children with scaphoid fracture nonunions treated at a single center were identified through an electronic database from 2010 to 2021, who underwent scaphoid nonunion repair through ORIF with a distal radius autograft were included. Exclusion criteria included a subject age of 19 years or older and a <6-month follow-up. Preoperative data included the interval between injury and surgery and initial x-ray and CT findings, including the presence of deformity, displacement, or avascular necrosis. Perioperative data included grafting, tourniquet time, and estimated blood loss. Pre- and postoperative carpal alignment were assessed. Postoperative data included immobilization time and time to union.
RESULTS
Thirty-five wrists in 35 patients met inclusion criteria (33 males, 2 females) with a mean age at presentation of 15.9±1.6 years (range 12.0 to 18.6 y) with a mean duration of radiographic follow-up of 11.1±4.9 months (range: 6.2 to 24.5 mo). Union was achieved in all wrists at a mean of 3.3±1.4 months (range: 1.3 to 7.7) postsurgery. Two wrists (6%) achieved union at ≥6 months post-op. Mean scapho-lunate angle decreased from preoperative (62.5±14.7 degrees) to postoperative (52.5±12.7 degrees), P<0.001. Mean radio-lunate angle decreased from preoperative (17.8±12.4 degrees) to postoperative (9.7±7.6 degrees), P<0.001. No intraoperative complications were noted. All but 3 subjects returned to activities at a mean of 9.6±4.4 months postsurgery.
CONCLUSIONS
Adolescent patients with scaphoid nonunion treated with ORIF with distal radius autograft have good outcomes, including a high rate of union, improved radiographic wrist parameters, and return to sport. Although achieving this positive outcome may take more than a year postoperatively, success is seen in 94% of adolescents.
LEVELS OF EVIDENCE
Level IV-case control study.