A Retrospective Review of Scaphoid Nonunion Treatment: Does Graft Type Impact Union Rate and Correction of Humpback Deformity?

Abstract Various modalities have been utilized in the treatment of scaphoid nonunion, including structural, non-structural, and vascularized bone grafts. This study was designed to assess the impact of bone graft type on the rate of union and correction of scaphoid height–length ratio (HLR). A multi-institution, retrospective review was conducted, identifying patients treated operatively for scaphoid nonunion between 2014 and 2024. Patients were categorized into three groups based on the graft utilized: Cancellous, non-vascularized corticocancellous, and pedicled vascularized bone graft. Outcomes evaluated included achievement of bony union and correction of scaphoid HLR. Additionally, the impacts of preoperative avascular necrosis (AVN) and the fixation method utilized on the union rate were investigated. Sixty-three patients underwent scaphoid nonunion repair with bone grafting between 2014 and 2024. Twenty-three patients were treated with vascularized bone graft, 17 patients were treated with cancellous-only autograft, and 23 patients were treated with corticocancellous autograft. There were no statistical differences in union rate between the three groups. The pooled union rate was 50/63 (79.3%). Union rates for vascularized, cancellous, and corticocancellous groups were 73.9%, 94.1%, and 73.9%, respectively. The preoperative presence of AVN was not found to have an effect on the postoperative union rate; however, the use of Kirschner wires for fixation was significantly associated with higher rates of nonunion. In general, patients who received corticocancellous bone grafts experienced a greater HLR correction postoperatively; however, this was not statistically significant when compared between groups. Union rate for treatment of scaphoid nonunion was highest with the utilization of cancellous only graft, and correction of the scaphoid HLR was greatest with the utilization of corticocancellous graft. Neither of these trends, however, reached statistical significance, likely due to low sample size. Union rate did not differ based on the presence of preoperative AVN, but was affected by the method of fixation utilized—use of K-wire fixation should be avoided.