Abstract
Background The natural history of scaphoid nonunion is the development of degenerative arthritis.
A lot of information is still unclear about this progression. The purpose of this
study is to analyze patients with scaphoid nonunions who had not received any kind
of treatment and to assess the functional outcome.
Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions
between 2009 and 2019. None of the patients received any treatment. The age at the
time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms,
and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed
tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate
angles were recorded. Pain score, modified mayo wrist score, grip strength, range
of movement, and the functional outcome of these scaphoid nonunions were analyzed.
A statistical correlation between the scaphoid nonunion presentations and the functional
outcome was assessed.
Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male
and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions.
The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of
the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination,
gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement
≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no
significant impact on the functional outcome.
Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis
over a period of years, which is still unpredictable. Most of the patients become
aware of the nonunion following a precedent injury or other reasons. Most of the patients
have fair/good functional outcome despite reduced range of movements and grip strength.
Many do not favor surgical intervention in the course of nonunion. Chronic nonunions
open a lot of unanswered questions.
Clinical Relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with
little knowledge about certain people with nonunion who did not have any kind of treatment.
The demographics, clinical findings, and radiological parameters do confirm the progression
of these nonunion to arthritis, but most of them had fair-to-good outcome throughout
their life. It opens our thinking about the real need of treatment in such nonunions
and raises numerous questions about the disease.
Level of Evidence This is a Level IV study.
Keywords
scaphoid nonunion - long-standing nonunion - no treatment - fair/good outcome - questions
