Scaphoid Non-Unions, Where Do They Come From? The Epidemiology and Initial Presentation of 270 Scaphoid Non-Unions

Abstract

Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. One-third of the non-unions were located in the proximal part of the scaphoid and the remaining two-thirds in the middle part. Of the 146 patients (55%) who contacted a doctor at the time of injury, 53 fractures where diagnosed (20%). Fourteen (5%) were operated primarily while 39 (15%) (seven dislocated) were immobilized in plaster casts. Thirty-two (12%) were under the age of 16 at the time of injury. The average time from the injury to the initial non-union surgery was 1.5 years with 2.8 years to the second procedure. The risk of osteoarthritis increased time from injury to surgery (both primary and secondary procedures). The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.

Ultrasonography of fractures in sports medicine

“…Of particular interest is fracture of the carpal scaphoid 15 23 24. When a scaphoid fracture is suspected clinically but radiographs are negative, CT or MR is often utilised to definitively diagnose the presence of a fracture.…”

Knöcherne Verletzungen der Handwurzel

“…Da der proximale Pol keine eigene, suffiziente Blutversorgung auf-weist, treten nach unbehandelten Skaphoidfrakturen im proximalen Drittel 3-bis 6-mal häufiger Pseudarthrosen und ggf. auch avaskuläre Nekrosen auf [23,28,32].…”

Bone Grafts for Scaphoid Nonunion: An Overview

“…1,2) For clinical purpose it is important to distinguish between non-displaced, displaced and proximal scaphoid fractures because the latter two types are at risk for nonunion. [3][4][5][6] Amirfeyz et al showed that all fractures with signs of consolidation on the CT-scan 4 weeks following trauma will heal with conservative treatment. However, only half of the fractures with >3 mm displacement will heal.…”

“…The risk of osteoarthritis increases with time from injury to surgery. 5,9) If there is already evidence of osteoarthritis on preoperative imaging, scaphoid surgery is not advised and other therapy is indicated instead.…”