Healing of ununited scaphoid fractures by Kirschner wires and autologous structural bone grafts

Untreated ununited scaphoid fractures are a hazard to the wrist because of increasing degenerative changes with time. We have treated 81 consecutive ununited scaphoid fractures by open reposition, autologous bone transplantation, and Kirschner wire fixation, 2.7 years after the primary injury. Sixty-nine were men and the mean age at operation was 29 (range 15-71) years. Anatomy of the wrist was restored and radiological healing confirmed in 72/81 patients. There were two deep infections, and the fractures did not heal. Patients with moderate preoperative arthritic wrist changes (scaphoid non-union advanced collapse (SNAC) stage 2) or ununited fractures of the proximal 1/6 of the scaphoid had worse healing than the remainder. Two of nine scaphoids that did not heal were reoperated on with autologous bone grafting and fixation with screws or pins, both of which healed successfully. Three salvage procedures (two wrist arthrodeses and one four corner fusion) were done and the remaining four declined further treatment. Our overall results are comparable to results published where alternative fixation methods have been used. We find that our standard method using Kirschner (K) wires and bone grafting is reliable and inexpensive for most scaphoid pseudarthroses and our results are comparable to published results when alternative fixation methods have been used.