Surgical treatment of carpal scaphoid non-union: a systematic review

Scaphoid non-union is a challenging orthopaedic condition, frequently resulting from missed or untreated fractures of the scaphoid bone. Delayed diagnosis or inadequate treatment can lead to long-term complications, such as osteoarthritis and carpal collapse. Various surgical techniques are employed to address scaphoid non-union, each with differing success rates and indications. This review aims to evaluate the most effective surgical interventions for scaphoid non-union and provide an overview of treatment outcomes and advances in the field.

A comprehensive literature search was performed using databases including PubMed and MEDLINE to identify studies published from 2014 to 2024. Articles that focused on surgical techniques for scaphoid non-union, including vascularized bone grafting, non-vascularized bone grafting, and fixation methods, were included. The primary outcomes assessed were union rates, functional outcomes, and complication rates across different techniques.

Surgical options for scaphoid non-union are varied and include non-vascularized bone grafting, vascularized bone grafting, PRP and fixation with K-wire, screws, staples or plates. Non-vascularized bone grafting is most effective in early-stage non-union with minimal bone resorption, while vascularized grafts show superior outcomes in avascular necrosis or cases with poor blood supply. Percutaneous screw fixation offers a minimally invasive option with high union rates, though complex cases often require open surgery. Also bone graft without any fixation is effective. Overall, the union rates ranged from 70 to 95%, with higher success in non-complex cases. Complications include graft failure, persistent non-union, and donor site morbidity.

Surgical treatment of scaphoid non-union is highly dependent on the stage of non-union, vascular status, and patient-specific factors. Vascularized bone grafting and advanced fixation techniques have improved outcomes, particularly in complex cases. However, optimal treatment requires individualized approaches based on the extent of non-union and blood supply. Future research should focus on refining surgical techniques and exploring regenerative approaches to enhance healing in difficult cases.