Nonunion of the scaphoid: analysis of the results from bone grafting.

Scaphoid nonunion was treated by bone-grafting techniques in 86 patients with 90 fractures. The volar inlay (Russe) technique had union in 38 of 44 fractures (86%); the dorsal inlay (Matti) technique in 20 of 22 fractures (91%); the dorsal peg graft (Murray) in nine of 18 fractures (50%); and compression screw osteosynthesis in one of six cases (17%). Fourteen patients had secondary arthritis associated with fracture union. Union was more frequent (85%) in 54 undisplaced nonunions than in 36 displaced nonunions (65%). Complications included avascular necrosis, secondary arthrosis, and persistent nonunion. Avascular necrosis in 13 nonunions was treated successfully by inlay grafts in 11, and postoperative avascular necrosis (four nonunions) was resolved after fracture healing in two. The four patients with failed results had the dorsal peg grafting technique. Of 22 persistent nonunions, 16 had secondary arthritis and four had avascular necrosis. The rate of union was increased when Kirschner wire fixation of unstable nonunions was performed. The dorsal and volar inlay techniques had consistently higher rates of union with fewer complications than did the dorsal peg grafting technique.