The Impact of Scapholunate Angle Correction on Radiographic Union in Adult Scaphoid Nonunion Surgery: An...

The objective of the study is to characterize factors associated with radiographic union and pain at final follow-up in surgical repair of scaphoid nonunion.

Patients who underwent scaphoid nonunion repair at our institution between 2005 and 2024 were retrospectively reviewed. Demographic and surgical factors were abstracted. Preoperative, immediate postoperative, and final follow-up scapholunate (SL) angles were measured. Radiographic union (>75% healing) and patient-reported pain at final follow-up were assessed. Associations between SL angle measurements, patient characteristics, and surgical variables with union and pain were evaluated using unpaired t tests and χ² tests.

Fifty-five patients met inclusion criteria with persistent nonunion occurring in 17 patients (30.1%). Patient sex was significantly associated with union (P = .045) but not pain at final follow-up (P = .399). All other demographic factors (smoking status, diabetes, prior surgery) and surgical factors (fracture location, surgical approach, implant type, graft type, and use of adjunct Kirschner-wire) were not significantly associated with union or pain at final follow-up (all P > .05). Among SL angle measurements, only a lower final follow-up SL angle was significantly associated with higher union rates (P = .038). No SL angle measurement was associated with pain at follow-up (all P > .05).

Patient sex was associated with union. No other demographic or surgical variables were associated with union or pain at final follow-up. A lower SL angle at final follow-up was independently associated with successful union, suggesting that correction of carpal alignment may contribute to improved healing in scaphoid nonunion repair.