Reconstruction of scaphoid waist non-unions using a radial approach: Preliminary outcome analyses

This study aimed to evaluate clinical and radiographic outcomes in a consecutive series of patients who underwent open surgery via a radial approach for reconstruction of scaphoid waist non-union. Over a 2-year period, 16 males with scaphoid waist non-union received surgery using a radial approach; we performed limited styloidectomy, biconcave curettage, ovoid bone grafting from the styloidectomy fragment, and placement of a retrograde radial-entry screw. Mean patient age was 25.1 years (range 17-56 years). Bony union was determined on radiographs and computed tomography. Radiographic variables were measured on preoperative and final follow-up radiographs. Mean follow-up was 14 months (range 8-19 months). Subjective and objective outcomes were recorded. Radiographic healing was achieved in 14 of the 16 patients (88%) at a mean 4½ months after surgery (range 3-6 months). Significant postoperative improvements were found in mean carpal height ratio (from 0.48 to 0.53) and radiolunate angle (from 8.2° to 2.8°) compared to preoperative data. Mean postoperative wrist extension was 54° (range 32-67°) and mean flexion 49° (range 2-64°). Mean flexion arc after surgery was 84.1% that of the contralateral side. Mean grip strength was 85.2% that of the contralateral side. Subjective results comprised mean postoperative Modified Mayo Wrist score of 82.3 (range 55-90) and Quick Disabilities of the Arm, Shoulder and Hand score of 11.2 (range 0-36.4). Twelve of the 14 healed wrists were subjectively rated as good or excellent. Repair of scaphoid non-union via a radial approach was safe and effective. Union rates were high and outcomes were good.