The role of surgical timing in 124 scaphoid nonunion surgical procedures

A total of 124 scaphoid nonunion surgical procedures performed between 2002 and 2020 were analyzed to investigate the potential impact of delayed diagnosis on time to union. The primary outcome was the correlation between the time from injury to surgery and the time to union. Secondary outcomes included identifying risk factors for delayed union and persistent nonunion following scaphoid nonunion surgery. The analysis revealed that time to union was similar for surgeries performed between 6 months and over 2 years post-injury. However, nonunion persisted in 12 cases, five of which involved surgeries conducted more than 2 years after the injury. Further investigation into secondary outcomes showed that fractures in the proximal third of the scaphoid took 1.4-1.5 times longer to unite compared to fractures in the middle and distal thirds. Additionally, fractures without trabecular bone required approximately twice as long to heal. In conclusion, surgical intervention performed between 6 months and over 2 years after injury generally offers a favorable outcome for healing. However, when surgery is delayed beyond 2 years, the risk of persistent nonunion increases.