Outcomes of Distal Radius Autograft in Adolescent Scaphoid Nonunion Repair

When treated early with cast immobilization, adolescent scaphoid fractures have excellent outcomes; however, nonunion may occur, particularly in patients with a delayed presentation. The purpose of this study is to evaluate the radiographic outcomes and to determine factors associated with time till union in adolescent scaphoid fracture nonunions treated with open reduction and internal fixation (ORIF) with distal radius cancellous autograft interposition.

Children with scaphoid fracture nonunions treated at a single center were identified through an electronic database from 2010 to 2021, who underwent scaphoid nonunion repair through ORIF with a distal radius autograft were included. Exclusion criteria included a subject age of 19 years or older and a <6-month follow-up. Preoperative data included the interval between injury and surgery and initial x-ray and CT findings, including the presence of deformity, displacement, or avascular necrosis. Perioperative data included grafting, tourniquet time, and estimated blood loss. Pre- and postoperative carpal alignment were assessed. Postoperative data included immobilization time and time to union.

Thirty-five wrists in 35 patients met inclusion criteria (33 males, 2 females) with a mean age at presentation of 15.9±1.6 years (range 12.0 to 18.6 y) with a mean duration of radiographic follow-up of 11.1±4.9 months (range: 6.2 to 24.5 mo). Union was achieved in all wrists at a mean of 3.3±1.4 months (range: 1.3 to 7.7) postsurgery. Two wrists (6%) achieved union at ≥6 months post-op. Mean scapho-lunate angle decreased from preoperative (62.5±14.7 degrees) to postoperative (52.5±12.7 degrees), P<0.001. Mean radio-lunate angle decreased from preoperative (17.8±12.4 degrees) to postoperative (9.7±7.6 degrees), P<0.001. No intraoperative complications were noted. All but 3 subjects returned to activities at a mean of 9.6±4.4 months postsurgery.

Adolescent patients with scaphoid nonunion treated with ORIF with distal radius autograft have good outcomes, including a high rate of union, improved radiographic wrist parameters, and return to sport. Although achieving this positive outcome may take more than a year postoperatively, success is seen in 94% of adolescents.

Level IV-case control study.