Elshahhat A, Ahmed M, Saleh A, Abed Y, Elashmawy H, Nour K. Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis. World J Orthop 2026; 17(2): 112889 [DOI: 10.5312/wjo.v17.i2.112889]
Corresponding Author of This Article
Amr Elshahhat, MD, PhD, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
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Orthopedics
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 18, 2026 (publication date) through Feb 4, 2026
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Elshahhat A, Ahmed M, Saleh A, Abed Y, Elashmawy H, Nour K. Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis. World J Orthop 2026; 17(2): 112889 [DOI: 10.5312/wjo.v17.i2.112889]
World J Orthop. Feb 18, 2026; 17(2): 112889 Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.112889
Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis
Amr Elshahhat, Moheib Ahmed, Ahmed Saleh, Yasser Abed, Hany Elashmawy, Khaled Nour
Amr Elshahhat, Moheib Ahmed, Ahmed Saleh, Yasser Abed, Hany Elashmawy, Khaled Nour, Department of Orthopedic Surgery, Mansoura University, Mansoura 33516, Dakahlia, Egypt
Author contributions: All authors contributed to the study conception and design; Elshahhat A, Ahmed M, Saleh A, and Abed Y contributed to material preparation; Elshahhat A and Elashmawy H contributed to data collection and analysis; Elshahhat A and Nour K contributed to the first draft of the manuscript. All authors were responsible for critical revision, and final approval of the manuscript.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Research Ethics Committee, Institutional Review Board of Mansoura Faculty of Medicine, Mansoura University (approve No. R.24.08.2743).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data is available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amr Elshahhat, MD, PhD, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
Received: August 8, 2025 Revised: September 25, 2025 Accepted: December 11, 2025 Published online: February 18, 2026 Processing time: 180 Days and 7.1 Hours
Abstract
BACKGROUND
Scaphoid nonunion (SNU) presents substantial functional limitations, frequently necessitating surgical intervention to restore wrist mobility and prevent degenerative changes. While the traditional approach to managing SNUs has relied on open fixation combined with bone grafting, the universal necessity of grafting, especially in stable nonunion (NU), is increasingly questioned. Emerging evidence indicates that graft-less fixation can deliver favorable outcomes, with notable healing observed in such cases.
AIM
To compare the outcomes of graft-less vs graft-augmented fixation in stable SNU, focusing on union rates (URs), healing time (HT), and functional recovery.
METHODS
A retrospective analysis of 44 patients with stable SNUs (Slade grades I-V) managed by either graft-less (n = 21) or graft-augmented (n = 23) fixation. Subgroup analysis included non-vascularized (n = 12) and vascularized grafts (n = 11). Clinical and radiological outcomes were assessed over a minimum 24-month follow-up. HT and UR were compared across groups concerning NU type, bone resorption, duration, and anatomical location.
RESULTS
Overall UR was 81.8%. URs did not differ significantly between groups (P > 0.05), whereas HT was significantly shorter with graft augmentation (P < 0.001). Graft-less fixation yielded superior grip strength (P < 0.001), radial/ulnar tilt (P = 0.004, < 0.001), and Mayo modified wrist scores (P = 0.01). Graft augmentation particularly improved outcomes in cystic SNUs, those with ≥ 5 mm bone loss, and NUs ≥ 1 year. Non-vascularized and vascularized grafts demonstrated comparable outcomes (UR: 91.7% vs 81.8%, P = 0.5). Smoking showed a significant association with delayed healing in graft-augmented fixation (P = 0.04), whereas no such relationship was observed in graft-less fixation.
CONCLUSION
Fixation without grafting is viable in selected stable SNUs, offering comparable union and superior function, albeit with longer HT. Bone grafting remains advantageous in cystic, long-standing, or biologically compromised NUs. Treatment should be tailored based on NU characteristics and patient factors.
Core Tip: This study compares graft-augmented and graft-less fixation in stable scaphoid nonunions. While grafting significantly shortened healing time, graft-less fixation yielded superior functional outcomes, particularly in grip strength and wrist motion. Subgroup analysis highlights the role of bone loss, nonunion duration, and smoking in guiding treatment choice. These findings support individualized fixation strategies and question the routine necessity of bone grafting in select cases.
