Prognostic factors in the treatment of carpal scaphoid nonunions

The aim of this multicenter study of: 138 patients with scaphoid nonunions was to assess the prognostic factors of bone healing or failure after curat ive surgical treatment options: isolated bone grafting (30%), internal fixa tion (23%), or combined bone grafting and internal fixation (47%). Bone hea ling occurred in 75% of cases. Persistent nonunion was evident in 20% of ca ses; it was possible in 6%. The clinical and radiologic results were worse in the group of failures. Stepwise multiple logistic regression analysis wa s conducted to identify the factors of prognosis toward bone healing or fai lure. In univariate analysis, professional heavy work, age of the nonunion of over 5 years, associated radial styloidectomy, and duration of postopera tive immobilization were associated with a significantly decreased likeliho od of healing of the scaphoid nonunion. In multivariate analysis, the only remaining predictor was the delay between the initial trauma and the treatm ent of the nonunion. Among the cases of internal fixation (with or without bone grafting), the only predictor in multivariate analysis was the importa nce of bone resorption. The dorsal approach resulted in a more pronounced l oss of wrist flexion and extension amplitudes. If the time elapsed between the initial fracture and the treatment of the nonunion exceeds 5 years, the chances of healing of the nonunion are decreased. (J Hand Surg 1999;24A:76 1-776. Copyright (C) 1999 by the American Society for Surgery of the Hand.) .