Restoring carpal alignment: Long-term outcomes of modified Fisk-Fernandez technique in scaphoid nonunion.

BACKGROUND

Scaphoid nonunion remains a challenging condition due to its tenuous vascularity and complex wrist biomechanics, often resulting in deformity, instability, and progressive degenerative changes. The modified Fisk-Fernandez technique combines structural bone grafting with stable fixation to address both biological and mechanical factors.

METHODS

This retrospective cohort study included 82 patients with scaphoid waist nonunion treated between 2017 and 2026. Clinical outcomes were assessed using QuickDASH and Visual Analog Scale (VAS) scores, while radiological evaluation included scapholunate angle and fracture union. Patients were followed for a minimum of 12 weeks and up to 9 years. Statistical analysis was performed using paired t-tests and regression analysis, with significance set at p < 0.05.

RESULTS

Union was achieved in 95.1% (78/82) of patients, with a mean time to union of 14.2 weeks. Significant improvement was observed in functional outcomes, with QuickDASH scores improving from 81.6 to 6.9 and VAS scores from 7.8 to 0.6 (p < 0.001). Radiological parameters demonstrated significant correction of scapholunate angle (68° to 46°, p < 0.001). Most patients reported good to favorable outcomes, with minimal complications and a low incidence of progression to SNAC wrist (3.6%).

CONCLUSION

The modified Fisk-Fernandez technique provides reliable union, effective deformity correction, and sustained functional recovery in scaphoid nonunion. It represents a safe and reproducible surgical option, particularly in young and active patients.

LEVEL OF EVIDENCE: Level IV.