Research Trends in the Management of Scaphoid Non-unions: A Bibliometric Review.

Background: The scaphoid is the most commonly fractured carpal bone, often going into non-union and secondary complications. Despite this, no explicit guidelines exist for the management of its non-union till date. This study quantitatively analyses the existent research on scaphoid nonunions from 2013 to 2024 using bibliometric methodology.

Materials And Methods: The Web of Science database was used to search for and extract publications using the keywords 'scaphoid' AND 'nonunion'. Articles were then filtered based on their eligibility, and the metadata of the remaining articles was analysed using bibliometric methodology (R software and VOSviewer application). Performance analysis and science mapping were performed to obtain the metrics for past, present, and future trends in research on scaphoid nonunions.

Results: A total of 272 articles were included in the study for bibliometric analysis after screening the initial 501 articles. There has been a rise in the number of articles published yearly, but the overall growth rate still remains negative. Developed nations with economic stronghold dominate in research, with the United States of America (USA) having the most published and cited articles. International collaborations in research were also lead by the USA with majority of its ties with Canada. The clearly remains the most productive and cited journal on this subject. Keywords analysis shows a shift from arthrodesis and excision towards bone grafting, arthroscopy, and internal fixation, indicating a future research trend towards minimally invasive procedures and evaluating the need for grafting.

Conclusions: There is a continually increasing research interest in scaphoid non-unions with a trend towards minimally invasive definitive treatment methods. The research, however, lacks major contributions from the developing world which need to be strengthened. The need for vascularized and non-vascularized grafts is still under evaluation, with an emerging opinion in favour of even graft-less fixation.