Management of scaphoid nonunion with iliac crest bone graft and K-wire fixation.

PURPOSE: Scaphoid nonunion can occur in both non-operative and operatively treated scaphoid fractures. Without treatment, this can lead to a predictable pattern of carpal collapse and degenerative arthritic change and patients can experience both pain and functional loss in the early and late phases of progression. An operative technique with a high success rate for union is important. This paper describes a technique for treatment of scaphoid nonunion with K-wire fixation and iliac crest cancellous bone graft.

METHODS

A retrospective review from 1996 to 2010 was performed on a single senior surgeon's private university-based practice. Patient demographic information and fracture characteristics were obtained to evaluate for influence on success and time to union.

RESULTS

There were 32 patients identified for inclusion in this study. Union was achieved in 100% of the patients, including 44% that had proximal pole fractures. The median time from injury to surgery was 41.86 weeks. The median time from surgery to healing was 17.93 weeks. Time to union was not affected by patient age, fracture location, smoking, alcohol use, or time to treatment.

CONCLUSION

K-wire fixation and ICBG for treatment of scaphoid nonunion using our technique have equal or superior union rates compared to other techniques in the literature. This paper highlights the keys to success using this method.

LEVEL OF EVIDENCE: Therapeutic Level IV.