Is Nonvascularized Autografting in the Proximal Scaphoid Nonunions Ineffective?

Abstract

Objectives: In this study, we aimed to evaluate the results of proximal scaphoid nonunion treated with nonvascularized bone grafting and screw fixation. Patients and methods: Thirteen patients who were treated surgically for proximal scaphoid nonunion with a minimum of one-year follow-up in our clinic were evaluated. Wrist movements were measured by standard goniometry and muscle strength by hand dynamometry. Nonunion was classified radiologically according to the Schernberg classification, while functional assessment was performed based on the Herbert-Fisher Grading System and the Mayo Clinic Modified Wrist Scoring System. Results: The mean follow-up period was 14 months (range, 12 to 40 months). Full union was observed in eight of 13 patients (61.5%). The mean time to union was 16 (range, 12 to 40) weeks. There was no loss of function of more than 10% compared to the healthy hand in the cases with full union. Postoperative mean grip strength was 37.3±3.0 kg. The rates of excellent and good results were 61.5%, moderate and poor results were 38.5% according to the Herbert-Fisher classification and the mean Mayo score was 80±13. Conclusion: We obtained no satisfactory results in patients treated with nonvascularized bone grafting and screw fixation for proximal scaphoid nonunions. We suggest that grafting should be carried out in selected cases due to the adverse effects of open techniques and bone grafting on vascularity of scaphoid bone.