Treatment of Scaphoid Nonunion: Radiologic Outcome of 286 Patients in 10 Years.

We analyzed the radiologic outcome of different treatment options for scaphoid nonunion. The results were compared with literature, and a treatment algorithm was proposed. On the basis of a retrospective case-control study, 286 patients suffering from scaphoid nonunion were treated over a 10-year period. Patients were grouped depending on the location of the nonunion: proximal ( = 126), middle ( = 130), or distal ( = 30) third. In the presence of an avascular proximal fragment or after prior unsuccessful operation, interposition of a vascularized pedicled bone graft from the distal radius was performed ( = 82). Scaphoid healing was detected by conventional radiography and computed tomography. Excellent healing rates of 96.3% were obtained for middle and distal third scaphoid nonunions by conventional iliac crest bone grafting ( = 137). Furthermore, we achieved healing rates of 91.3% for persistent nonunions using a palmar vascularized bone graft from the distal radius after prior unsuccessful operation ( = 23). When using a dorsal vascularized bone graft from the distal radius, scaphoid consolidation was reached in 81.1% for avascular proximal fragments ( = 59). Applying a sophisticated treatment algorithm, the prognosis of scaphoid nonunion is very good.