Abstract
Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion
due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions
remains controversial.
Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions
(delayed unions) and nonunions that underwent surgical fixation with a cannulated
headless compression screw and local autologous bone graft from the distal radius.
Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record
of one tertiary care center was queried for patients with the diagnosis of “proximal
pole scaphoid fractures” who underwent surgical fixation by a single surgeon over
an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review
of records, four patients were excluded due to the acute nature of the fracture, and
one was excluded as surgical fixation included a vascularized bone graft.
Results The final study cohort consisted of 10 patients with a total of 10 proximal pole
scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]),
and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric
measurements of the scaphoid fractures on computed tomography (CT) revealed that the
mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks),
with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating
partial union. None of the patients required additional procedures and there were
no complications.
Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and
nonunion treated with surgical fixation and autologous local bone graft heal without
the need for more complex vascularized procedures. The volume of the proximal pole
fragment did not correlate with increased risk of ongoing nonunion after the index
procedure.
Level of Evidence This is a Level IV, case series study.
Keywords
proximal pole scaphoid - nonunion - local autograft
