The outcome of bone graft surgery for nonunion of fractures of the scaphoid

Abstract

Data on 806 patients undergoing bone graft surgery for a scaphoid fracture nonunion were retrospectively collected at 19 centres in the United Kingdom. Each centre contributed at least 30 cases. Sufficient data were available in 462 cases to study factors that influenced the outcome of surgery. Overall union occurred in at least 69%, and nonunion in at least 22%, with 9% of cases having ‘uncertain union status’. Union appeared to be adversely influenced by smoking and the time between acute scaphoid fracture and nonunion surgery, with adjusted odds ratios of 1.8 and 2.4, respectively, but neither achieved the pre-determined significance level of 0.003. The type of bone graft (vascular vs non-vascular; iliac crest vs distal radius) did not appear to influence outcome. Further large multicentre prospective studies with clear definitions of ‘union’ and other factors are needed to clarify whether modification of surgical technique can influence union. Level of evidence: IV

Pedicled vascularized versus non‐vascularized bone grafts in the treatment of scaphoid non‐union: a meta‐analysis of comparative studies

“…Whether the greater technical difficulty of PVBGs resulted in more complications could not be clarified. Our finding are consistent with many recent published studies 43,48 . In Ammori et al .…”

“…In Ammori et al . 's 48 retrospective study, data on 806 patients treated with bone graft surgery for a scaphoid fracture non‐union were collected at 19 centres. The results demonstrated type of bone graft (vascular versus non‐vascular; iliac crest versus distal radius) did not appear to influence outcome.…”

Bone grafting for scaphoid nonunion surgery

“…This review is in line with best practice recommendations from the Cochrane guidelines, which cite that the median time for a review to require an update is 5.5 years, 90 and state that an update may be indicated if the research question is still relevant; there is new available evidence that has the potential to change or clarify findings. 91 There is still considerable debate regarding the optimal graft choice for scaphoid nonunion management, 75 and our update adds a further 30 studies to the most recent comparable review. 7 Despite these additions and the evolving knowledge of scaphoid fractures in recent years, there does not appear to be improved union rates over the last decade, and the rates of union with compression screws were not significantly different from other techniques.…”

Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion

“…There is no agreement in the definition of radiological union after scaphoid fracture surgery. Nonunion was defined as a fracture that had not united within 12 weeks of the acute injury based on plain radiographs or computed tomography (CT) scans [39]. One review found that the radiological features of union are the absence of bridging trabeculae [40] or the absence of a complete gap between the fracture fragments on any image, as well as no evidence of loosening of the fixation screw or wires [41].…”