Scaphoid waist nonunion with humpback deformity treated without structural bone graft

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Scaphoid nonunion with collapse and bone loss typically requires structural corticocancellous bone grafting.
• Restoring length and alignment in these complex fractures is crucial for functional recovery.

Purpose of the Study:

• To evaluate the efficacy of using only cancellous interposition bone graft with internal screw fixation for treating scaphoid waist nonunion with bone loss.
• To determine if this simplified technique can restore scaphoid length and carpal alignment.

Main Methods:

• A cohort of 12 patients with scaphoid waist nonunions underwent open reduction and internal screw fixation.
• Cancellous autograft from the distal radius was used to fill the bone defect.
• Postoperative CT imaging assessed union and correction of deformity.

Main Results:

• All 12 patients achieved scaphoid union at a minimum 2-year follow-up.
• Significant improvements were observed in wrist extension and grip strength.
• Functional scores (DASH, Mayo wrist) improved, and the intrascaphoid angle normalized.

Conclusions:

• Internal screw fixation combined with cancellous bone grafting is a viable and effective treatment for scaphoid nonunion with bone loss.
• This method simplifies surgical technique, utilizes local autograft, and promotes rapid bone incorporation.
• The technique successfully restores scaphoid reduction and carpal alignment without compromising outcomes.