Scaphoid Fracture Non-union: A systematic Review of Surgical Treatment

Background: The scaphoid is the largest carpal bone of the proximal row and is located on the radial side of the carpus. Non-union of scaphoid fractures is challenging and many treatment options are in use. Aim and objectives: This study was performed a systematic review and meta-analysis of randomized trials on the treatment of scaphoid nonunion, using both non- vascularized and vascularized bone flaps [VBFs] Methods: This study included recent clinical trials, case reports, and retrospective case follow-up of any surgical treatment for scaphoid fracture non-union. The PRISMA guidelines were used to conduct this work. In short searching using the Mesh [Scaphoid] OR [carpal, nonunion, malunion, mal-united, un-united, scaphoid non-union advanced collapse, Scaphoid non-union advanced collapse [SNAC], avascular necrosis, pseudarthrosis, vascularized bone graft, pedicled bone graft]. Then screening of article followed by downloading papers that fulfill the inclusion criteria and excluding papers with exclusion criteria. Data of studies fulfilling all entered to R-based software for meta-analysis. Results: Vascular bone grafting was associated with lower extension-flexion active range of motion, lower Extension degrees, higher Flexion degrees, lower Radial deviation, lower Scapholunate angle\post, lower Mayo wrist score, lower VAS score and lower Q-DASH score. However, no significant difference was found between both procedures in terms of bone union, revision, repeat nonunion repair without vascularized bone graft, and time to union, ulnar deviation and grip strength. Conclusion: Both vascular and non-vascular bone grafting were safe and effective in the treatment of scaphoid nonunion. However, although vascular graft had non-Significant higher union rate, it needs more technical experience.