Journal of clinical orthopaedics and trauma · 2026
Tricortical iliac crest wedge grafting with headless screw fixation for unstable scaphoid waist nonunion: Union rates and two-year functional outcomes.
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Singh Vivek, Gowda Aditya K S, Mishra Rahul, R Harisha, C Arjun, Regmi Anil
Аннотация
BACKGROUND: Unstable scaphoid waist nonunion disrupts wrist biomechanics through scaphoid shortening, humpback deformity, and dorsal intercalated segment instability (DISI), predisposing to degenerative collapse. Structural bone grafting aims to restore scaphoid length and alignment in addition to achieving union. This study evaluated radiological and functional outcomes following tricortical iliac crest wedge grafting for unstable scaphoid waist nonunion.
METHODS: A retrospective analysis was conducted on 40 adult patients with unstable scaphoid waist nonunion treated using a volar tricortical iliac crest cortico-cancellous wedge graft (Fisk-Fernandez technique). Fixation was achieved with a headless compression screw in 39 patients and Kirschner wire in one. Instability was defined by a scapholunate angle >60°, radiolunate angle >10°, and lateral intrascaphoid angle >35°. Outcomes assessed included union rate and time to union, wrist range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, modified Mayo Wrist Score (MMWS), and radiological parameters (scaphoid length, scapholunate angle, radiolunate angle, and lateral intrascaphoid angle). Minimum follow-up was 24 months.
RESULTS: Union was achieved in 38 of 40 patients (95%), with a mean time to union of 15 weeks (range 12-17). At final follow-up, dorsiflexion improved from 39 ± 11° to 62 ± 14° (p = 0.03) and palmar flexion from 56 ± 18° to 64 ± 19° (p = 0.04). Grip strength improved from 54 ± 12% to 76 ± 14% (p = 0.02). DASH scores improved from 56 ± 12 to 13 ± 8 and MMWS from 44 ± 6 to 73 ± 4 (both p < 0.001). Radiologically, scaphoid length increased from 22 (20-23) mm to 26 (25-27) mm, with significant correction of scapholunate, radiolunate, and lateral intrascaphoid angles (all p < 0.001).
CONCLUSION: Tricortical iliac crest wedge grafting with stable fixation reliably achieves union while restoring scaphoid alignment and wrist function in unstable scaphoid waist nonunion.
METHODS: A retrospective analysis was conducted on 40 adult patients with unstable scaphoid waist nonunion treated using a volar tricortical iliac crest cortico-cancellous wedge graft (Fisk-Fernandez technique). Fixation was achieved with a headless compression screw in 39 patients and Kirschner wire in one. Instability was defined by a scapholunate angle >60°, radiolunate angle >10°, and lateral intrascaphoid angle >35°. Outcomes assessed included union rate and time to union, wrist range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, modified Mayo Wrist Score (MMWS), and radiological parameters (scaphoid length, scapholunate angle, radiolunate angle, and lateral intrascaphoid angle). Minimum follow-up was 24 months.
RESULTS: Union was achieved in 38 of 40 patients (95%), with a mean time to union of 15 weeks (range 12-17). At final follow-up, dorsiflexion improved from 39 ± 11° to 62 ± 14° (p = 0.03) and palmar flexion from 56 ± 18° to 64 ± 19° (p = 0.04). Grip strength improved from 54 ± 12% to 76 ± 14% (p = 0.02). DASH scores improved from 56 ± 12 to 13 ± 8 and MMWS from 44 ± 6 to 73 ± 4 (both p < 0.001). Radiologically, scaphoid length increased from 22 (20-23) mm to 26 (25-27) mm, with significant correction of scapholunate, radiolunate, and lateral intrascaphoid angles (all p < 0.001).
CONCLUSION: Tricortical iliac crest wedge grafting with stable fixation reliably achieves union while restoring scaphoid alignment and wrist function in unstable scaphoid waist nonunion.