Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis

Table 4 Summary of case series reporting graft-less and graft-augmented fixation for scaphoid nonunion

Ref.	n (M:F)	Age (years)	Site	NU-duration	Approach	Follow-up	Clinical results	Healing time	Union rate/judgement
Graft-less fixation of scaphoid nonunion
Tada et al[14], 2021, retrospective study	19 (19:0)	29.2	Waist/PP/distal pole	14.8 weeks	Open (volar/dorsal)	NR	NR	3.7 months	17/19 (89.4%); X-ray, CT
Belloti et al[6], 2020, prospective study	12 (NR)	R: 27-40	Waist/PP	> 6 months	PC (volar/dorsal)	6 months	Flexion: 59.1°, extension: 48.7°; DASH: 6.99, PWRE: 7.97	NR	12/12 (100%); X-ray
Gurger et al[9], 2018, retrospective study	12 (10:2)	27	Waist/PP	7.6 months	PC (volar)	4.5 months	Flexion: 68°, extension: 66°; MMW: Excellent (n = 8) and good (n = 3)	3.8 months	11/12 (91.6%); X-ray, CT
Cha et al[8], 2017, retrospective study	15 (15:0)	28.9 ± 6.2	Waist	10.8 months	PC (volar)	12 months	Flexion: 69°, extension: 68°; DASH: 7 ± 3.9	5.5 months	15/15 (100%); X-ray, CT
Somerson et al[13], 2015, retrospective study	14 (13:1)	21.1 ± 10.6	Waist/PP	> 6 months	PC (volar/dorsal)	NR	Flexion: 73°, extension: 66°; DASH: 10.2	4.4 months	12/14 (85.7%); X-ray
Hegazy[10], 2015, case series	21 (17:4)	23	Waist	6.8 months	PC (volar)	25 months	Flexion: 74°, extension: 75°; DASH: 8	4 months	21/21 (100%); X-ray, CT
Capo et al[7], 2012, retrospective study	12 (11:1)	24	Waist	8.7 months	PC (volar/dorsal)	35 months	Flexion: 71°, extension: 66°; DASH: 6	4 months	11/12 (91.6%); X-ray
Mahmoud and Koptan[11], 2011, prospective study	27 (26:1)	28.3	Waist	18.2 months	PC (volar)	24.6 months	Flexion: 65.7°, extension: 60.7°; MMW: Excellent (n = 25) and good (n = 2)	2.9 months	27/27 (100%); X-ray, CT
Slade et al[12], 2003, prospective study	15 (14:1)	20	Waist/PP	9 months	PC (dorsal)	35 months	Flexion: 61°, extension: 49°; MMW: Excellent (n = 12) and good (n = 3)	3.5 months	15/15 (100%); X-ray
Graft-augmented fixation of scaphoid nonunion
Zondervan et al[27], 2024, retrospective	8 (8:0)	R: 16-28	Waist/PP	13 months	Cancellous DR BG (dorsal)	88.9 months	Flexion-extension arc: 143.7° ± 13.9°; median DASH: 2.9	12 weeks	85.7%; X-ray
Bhat et al[21], 2023, retrospective	38 (36:2)	28.7 ± 7.9	Waist/PP/distal pole	18.7 ± 4.9 weeks	Cancellous DR BG (volar)	22.2 months	Clinical outcome: NR; complications: Screw prominence (n = 1), grade 1 SNAC (n = 1)	15.7 ± 3 weeks	100%; X-ray
Ma et al[23], 2023, retrospective study	21 (18:3)	29.8 (R:18-46)	Waist/PP	38.3 months	IC BG (volar)	30.6 months	Flexion-extension arc: 118° ± 46°; PRWE: 14 ± 11, VAS: 3 ± 1, grip strength: 83% ± 26%	2.7 months (R: 2-4)	100%; X-ray
Schäfer et al[26], 2023, retrospective study	16 (16:0)	29 (R: 18-41)	Waist/PP	17 months (R: 6-60)	IC NVBG (volar/dorsal)	54 months	Flexion: 55°, extension: 50.1°; DASH: 2.36, grip strength: 99% (R: 72%-134%)	12.9 weeks (R: 11-15)	73%; X-ray, CT
Papatheodorou et al[25], 2021, retrospective study	64 (45:19)	27 (R: 19-42)	PP	23 months (R: 12-47)	DR VBG (dorsal)	32 months (R: 24-56)	Extension: 70°, flexion: 47°; MMW: 86, grip strength: 83%; complications: Persistent nonunion (n = 8), fibrous union (n = 1)	12 weeks	55/64 (86%); X-ray, CT
Manako et al[24], 2023, retrospective study	5 (5:0)	Med: 30; R: 18-41	Waist/PP	≥ 6 months	Zaidemberg’s DR VBG (volar/dorsal)	Med: 24 months; R: 8-30 months	MMW score: 95 points (R: 75-100)	4.25 months	4/5 (80%); X-ray
Keller et al[22], 2020, retrospective study	37 (36:1)	26.2	Waist/PP	51 months	MFC VG (volar ± dorsal assisted)	16 months	Flexion: 44° ± 16°, extension: 50° ± 15°; DASH: 19, PRWE: 30; grip strength: 44 kg, VAS: 5; complications: Hardware irritation necessitated implant removal (n = 4), late infection (n = 1), venous bleeding (n = 1), postoperative boutonniere-like deformity of thumb MCPJ (n = 1), delayed wound healing of volar approach (n = 1)	16 weeks (R: 12-22)	95%; X-ray, CT

M:F: Male-female ratio; NU: Nonunion; PP: Proximal pole scaphoid; NR: Not reported; CT: Computed tomography; R: Range; PC: Percutaneous; DASH score: Disabilities of Arm, Shoulder and Hand score; PWRE: Patient-rated Wrist Evaluation; MMW score: Mayo modified wrist score; DR: Distal radius; BG: Bone graft; SNAC: Scaphoid nonunion advanced collapse; IC: Iliac crest; VAS: Visual analogue scale; NVBG: Non-vascularized bone graft; VBG: Vascularized bone graft; Med: Median; MFC: Medial femoral condyle; VG: Vascularized graft; MCPJ: Metacarpo-phalangeal joint.