PLAIN FILM EVALUATION OF BONE-GRAFTING FOR NONUNITED SCAPHOID FRACTURES

Objective. To determine how the appearance of fracture line bridging a nd graft incorporation changed on sequential plain films obtained duri ng the healing of successful grafts for scaphoid nonunion. Design. We identified 50 patients who had healed Russe bone grafts for nonunited scaphoid fractures. These patients had 214 sets of wrist radiographs o btained 1-36 months after surgery. Each set of radiographs was reviewe d in random order by two observers who were blinded as to the patient' s name and the time interval since surgery. Closure of the fracture li ne and the presence of a linear lucency in each of six zones surroundi ng the graft were assessed using a three-point grading scale. Patients . Forty-six men and four women were included in the study. Their mean age was 30 years with a range from 21-43 years. Results and Conclusion s. With increasing time after surgery, there was progressive fracture line closing and disappearance of linear lucencies at the interfaces b etween the scaphoid and the graft. However, 20% of the patients had a well-defined lucency in at least one of the six zones around the graft on their last film. Even 1 year after surgery, the fracture line show ed no bridging on the radial side in 22% of patients and on the ulnar side in 11%, We conclude that after grafting, most scaphoid nonunions show progressive fracture line closure and graft incorporation. Howeve r, the fracture line may not completely close and lucencies may persis t in several zones around the graft for more than 1 year. These radiog raphic appearances should be recognized as part of the normal spectrum of healing.