Scaphoid Nonunion Is a Disabling Problem in a Military Population.

Area of Science:

• Orthopedic surgery
• Trauma care
• Military medicine

Background:

• Scaphoid nonunion occurs in up to 55% of displaced scaphoid fractures.
• Long-term functional outcomes and return to active military service rates after scaphoid nonunion treatment are not well-documented.
• This study aims to provide insights into expected functional outcomes and return to duty post-scaphoid nonunion repair.

Purpose of the Study:

• To evaluate union rates after scaphoid nonunion repair.
• To determine return to active duty rates following surgical treatment.
• To assess long-term functional outcomes using validated scoring systems.

Main Methods:

• Retrospective review of 144 patients undergoing scaphoid nonunion repair (2008-2017).
• Primary outcomes included surgical union, return to duty, and functional scores (qDASH) via telephone follow-up.
• 40 patients completed long-term follow-up at an average of 5.9 years.

Main Results:

• Achieved surgical union in 72% of patients; 18% required revision surgery.
• 74% initially returned to full duty, but this rate decreased over time (1, 2, and 5 years).
• Mean long-term qDASH score was 23.9, significantly higher (indicating more disability) in those with persistent nonunion (29.2) versus achieved union (21.9).

Conclusions:

• Scaphoid nonunion presents challenges in military populations, often necessitating revision surgery, including wrist arthrodesis.
• Long-term functional outcomes can be significantly impaired, even after successful union.
• Findings aid in counseling patients and managing expectations regarding recovery and duty status after scaphoid nonunion treatment.