RADIOLOGICAL OUTCOME OF SCAPHOID NONUNION TREATED WITH TRICORTICAL ILIAC CREST AUTOGRAFT
Abstract
Background: Fractures of the scaphoid are one of the most common significant wrist injuries. Most of these fractures, if diagnosed early and treated promptly, heal well. This study aimed to determine the radiological outcome of scaphoid nonunion treated with tricortical iliac crest autograft.
Materials & Methods: A total of 30 patients were included in the study. Patients who had trauma three or more months back and had a visible fracture and a humpback were included in the study. In contrast, patients who were previously operated on for scaphoid pathologies or had preexisting arthritis were excluded. Plain radiographs in AP (including scaphoid), Lateral view, CT and MRI, were ordered, and baseline investigations were done in all patients.
Results: Out of the included 30 patients, 26 (86%) were male, and the remaining 04 (14%) were female. The mean age of our patients was 32.5±5.87 years. Right-sided scaphoid nonunion was present in 21 (70%) patients and left in 09 (30%) patients. The dominant hand was involved in 23 (76.66%) patients, while 07 (23.34%) had involvement of their nondominant hand. The majority (73.3%, n=22) of patients had nonunion scaphoid due to failed conservative treatment, while 08 (26.6%) patients had nonunion due to delay in diagnosis. Postoperatively all patients achieved radiological union. The mean union time was 12±3 weeks. All patients followed up to 24±3 weeks.
Conclusion: Scaphoid nonunion can be treated with a bone graft from iliac crest graft along with fixation with Herbert headless compression screw with an excellent radiological outcome.
Keywords
Full Text:
PDFReferences
Testa G, Lucenti L, D'Amato S, Sorrentino M, Cosentino P, Vescio A, et al. Comparison between vascular and non-vascular bone grafting in scaphoid nonunion: a systematic review. J Clin Med. 2022 Jun 14;11(12):3402. https://doi.org/10.3390/jcm11123402
Van Nest D, Ilyas AM. Scaphoid nonunion: a review of surgical strategies. Orthopedics. 2022 Sep 1;45(5):e235-42. https://doi.org/10.3928/01477447-20220608-03
Duncumb JW, Robinson PG, Williamson TR, Murray IR, Campbell D, Molyneux SG, et al. Bone grafting for scaphoid nonunion surgery: a systematic review and meta-analysis. Bone Joint J. 2022 May 1;104(5):549-58. https://doi.org/10.1302/0301-620X.104B5.BJJ-2021-1114.R1
Andreoletti MA, Molisani D, Piarulli G, Grismondi CE. Treatment of scaphoid waist nonunion with a modified Matti-Russe technique: our experience. Biomed J Sci Tech Res. 2017;1(3):743-7. https://doi.org/10.26717/BJSTR.2017.01.000292
Hovius SE, de Jong T. Bone grafts for scaphoid nonunion: an overview. Hand Surg. 2015;20(2):222-7. https://doi.org/10.1142/S0218810415400043
Burnier M, Loisel F, Ardouin L, Beauthier V, Durand A, Erhard L, et al. Treatment of scaphoid nonunion by arthroscopic cancellous bone grafting. Orthop Traumatol Surg Res. 2023 Dec 1;109(8):103665. https://doi.org/10.1016/j.otsr.2023.103665
Gray RR, Halpern AL, King SR, Anderson JE. Scaphoid fracture and nonunion: new directions. J Hand Surg Eur Vol. 2023 Sep;48(2 Suppl):4S-10S. https://doi.org/10.1177/17531934231165419
Patterson ED, Elliott C, Dhaliwal G, Sayre EC, White NJ. Risk factors for the development of persistent scaphoid nonunion after surgery for an established nonunion. Hand (N Y). 2024 Jan 9:15589447231219523. https://doi.org/10.1177/15589447231219523
Davis T. Prediction of outcome of non-operative treatment of acute scaphoid waist fracture. Ann R Coll Surg Engl. 2013;95(3):171-6. https://doi.org/10.1308/003588413X13511609956895
Labèr R, Lautenbach G, Schweizer A. Reasons for scaphoid nonunion: analysis of behavior of health care providers and patients. Hand Surg Rehabil. 2024 Apr 1;43(2):101662. https://doi.org/10.1016/j.hansur.2024.101662
Ammori MB, Elvey M, Mahmoud SS, Nicholls AJ, Robinson S, Rowan C, et al. The outcome of bone graft surgery for nonunion of fractures of the scaphoid. J Hand Surg Eur Vol. 2019;44(7):676-84. https://doi.org/10.1177/1753193419841278
Singh V, Moger NM, Jaisankar P, Rajkumar S, Chaudhary S, Azam Q. Nonvascularized tri-cortical iliac crest graft—a reliable option in the management of scaphoid waist nonunions. J Hand Surg Asian Pac Vol. 2021;26(3):383-9. https://doi.org/10.1142/S2424835521500363
Fowler JR, Ilyas AM. Headless compression screw fixation of scaphoid fractures. Hand Clin. 2010;26(3):351-61. https://doi.org/10.1016/j.hcl.2010.04.005
Slade JF 3rd, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg. 2008;97(4):280-9. https://doi.org/10.1177/145749690809700402
Ramamurthy C, Cutler L, Nuttall D, Simison AJ, Trail IA, Stanley JK. Factors affecting outcome after nonvascular bone grafting and internal fixation for nonunion of the scaphoid. J Bone Joint Surg Br. 2007;89(5):627-32. https://doi.org/10.1302/0301-620X.89B5.18183
Han SH, Lee HJ, Hong IT, Kim U, Lee SJ. Non-structural cancellous bone graft and headless compression screw fixation for treatment of scaphoid waist nonunion. Orthop Traumatol Surg Res. 2017;103(1):89-93. https://doi.org/10.1016/j.otsr.2016.10.016
Lee SK, Byun DJ, Roman-Deynes JL, Model Z, Wolfe SW. Hybrid Russe procedure for scaphoid waist fracture nonunion with deformity. J Hand Surg Am. 2015;40(11):2198-205. https://doi.org/10.1016/j.jhsa.2015.07.028
Tambe AD, Cutler L, Murali SR, Trail IA, Stanley JK. In scaphoid nonunion, does the source of graft affect outcome? Iliac crest versus distal end of radius bone graft. J Hand Surg Eur Vol. 2006;31(1):47-51. https://doi.org/10.1016/j.jhsb.2005.07.008
Finsen V, Hofstad M, Haugan H. Most scaphoid nonunions heal with bone chip grafting and Kirschner-wire fixation. Thirty-nine patients reviewed 10 years after operation. Injury. 2006;37(9):854-9. https://doi.org/10.1016/j.injury.2006.04.120
Bushnell BD, McWilliams AD, Messer TM. Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. J Hand Surg Am. 2007;32(6):827-33. https://doi.org/10.1016/j.jhsa.2007.04.003
DOI: https://doi.org/10.46903/gjms/23.1.1143
Refbacks
- There are currently no refbacks.
Copyright (c) 2025. Qaisar Azim, Ahmad Jawad Mufti, Nouman Rauf, Muhammad Shah Fahad, Qazi Shahrukh

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan
ISSN: 1819-7973, e-ISSN: 1997-2067
Website: https://www.gmcdikhan.edu.pk
Phone: +92-966-747373

