Structural Versus Nonstructural Bone Grafting for the Treatment of Unstable Scaphoid Waist Nonunion Without Avascular Necrosis: A Randomized Clinical Trial

PurposeWe evaluated the impact of structural versus nonstructural bone grafting on time to union, scaphoid deformity correction, and clinical outcomes in adults with unstable waist nonunion without avascular necrosis. We hypothesized that would provide earlier restoration anatomy, equivalent compared grafting.MethodsWe prospectively randomized 98 patients undergo open reduction, iliac crest either corticocancellous (CC group) or cancellous only (C-only), internal fixation using a Herbert screw. The lateral intrascaphoid angle (LISA) height length ratio (HLR) were measured wrist computed tomography scans along longitudinal axis before surgery an average 84 weeks afterward. Pain, range motion, grip strength, Quick–Disabilities Arm, Shoulder, Hand (QuickDASH) score afterward.ResultsThe trajectory union showed higher rate C-only group at 12, 14, 16 after surgery. However, 24 surgery, there was no difference between groups, 94% treated 90% CC grafting. In preoperative LISA less than 70° and/or HLR 0.80 (n = 53), differences techniques for radiographic outcomes, QuickDASH scores, malunion rate. who had greater 45), outcome measures, scores significantly better group. Scaphoid observed 9 22 (41%) 4 23 (18%).ConclusionsThe severity may be factor determining best graft type, because this affect successful correction. Corticocancellous high degree provided consistent correction superior scores. Otherwise, provides grafting.Type study/level evidenceTherapeutic I. (18%).