Comparison of MDCT Imaging and HR-pQCT for Assessment of Osseus Consolidation in Symptomatic Scaphoid Non-Union Treated with Avascular Bone Grafting and Percutaneous Screw Fixation—A Prospective Clinical Pilot Study

<b>Background/objectives:</b> This study prospectively evaluated clinical outcomes and osseous consolidation in patients with symptomatic scaphoid non-union treated with avascular bone grafting and percutaneous screw fixation. Two imaging methods, MDCT (multi-detector computed tomography) and HR-pQCT (high-resolution peripheric quantitative computer tomography), were employed to assess bone healing. <b>Methods:</b> In Vienna, eight consecutive patients with nine symptomatic scaphoid non-unions underwent revision surgery. Clinical outcomes were measured using DASH and PRWE scores, grip strength, and thumb strength. MDCT and HR-pQCT imaging were conducted 6 and 12 weeks post-operatively. <b>Results:</b> The median DASH score improved significantly from 43.3 (range 3.3-76.7) pre-operatively to 26.6 (<i>p</i> = 0.024) at 3 months and 16.2 (<i>p</i> = 0.06) at 12 months post-operatively. At 5-6 years, the median DASH score was 2 (range 0-15). At 6 weeks, both MDCT and HR-pQCT detected >50% bone healing at the distal interface. At the proximal interface, HR-pQCT detected >50% healing in all cases, whereas MDCT still showed <50% healing in 25% of cases. By 12 weeks, both methods demonstrated >50% osseous consolidation at both interfaces. <b>Conclusions:</b> Avascular iliac grafting with screw fixation achieved excellent long-term clinical outcomes for symptomatic scaphoid non-union. HR-pQCT proved superior to MDCT for assessing early bone healing.