Prognostic factors in the treatment of carpal scaphoid nonunions

The aim of this multicenter study of 138 patients with scaphoid nonunions was to assess the prognostic factors of bone healing or failure after curative surgical treatment options: isolated bone grafting (30%), internal fixation (23%), or combined bone grafting and internal fixation (47%). Bone healing occurred in 75% of cases. Persistent nonunion was evident in 20% of cases; it was possible in 6%. The clinical and radiologic results were worse in the group of failures. Stepwise multiple logistic regression analysis was conducted to identify the factors of prognosis toward bone healing or failure. In univariate analysis, professional heavy work, age of the nonunion of over 5 years, associated radial styloidectomy, and duration of postoperative immobilization were associated with a significantly decreased likelihood of healing of the scaphoid nonunion. In multivariate analysis, the only remaining predictor was the delay between the initial trauma and the treatment of the nonunion. Among the cases of internal fixation (with or without bone grafting), the only predictor in multivariate analysis was the importance of bone resorption. The dorsal approach resulted in a more pronounced loss of wrist flexion and extension amplitudes. If the time elapsed between the initial fracture and the treatment of the nonunion exceeds 5 years, the chances of healing of the nonunion are decreased.