Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis

Figure 1 Flowchart outlining the patient selection process. SNAC: Scaphoid nonunion advanced collapse; DISI: Dorsal intercalated segment instability; SNU: Scaphoid nonunion; MRI: Magnetic resonance imaging; FU: Follow-up.

Figure 2 Radiographic evaluation of waist nonunion managed via the mini-dorsal approach. A: Intraoperative clinical image demonstrating the inverted L-shaped capsulotomy used in the mini-dorsal approach. The transverse limb (white dashed line) is located at the radio-scaphoid interval, while the longitudinal limb (blue dashed line) lies ulnar to the scapholunate ligament interval; B: Preoperative anteroposterior radiograph showing a waist nonunion; C and D: Postoperative anteroposterior (C) and scaphoid-view (D) radiographs at seven months, showing complete healing.

Figure 3 Radiological evaluation of graft-less fixation for proximal pole nonunion. A: Preoperative anteroposterior wrist radiograph indicating a proximal pole nonunion; B-E: Sagittal and coronal computed tomography slices illustrating the nonunion with cyst changes and bone resorption; F and G: Follow-up radiographs at three-months (anteroposterior and lateral views) demonstrating healing after graft-less fixation; H: Anteroposterior wrist radiograph at five-months confirming full consolidation.

Figure 4 Healing outcome of waist nonunion fixed with cancellous bone grafting. A: Intraoperative fluoroscopic image showing fixation of a waist nonunion using cancellous bone grafting harvested from the distal radius; a small fragment of a broken drill bit is embedded in the proximal pole; B-F: Postoperative anteroposterior and scaphoid-view radiographs and corresponding sagittal and coronal computed tomography slices at three months, showing complete healing.

Figure 5 Failure of union after graft-augmented fixation for waist nonunion. A: Postoperative anteroposterior radiograph one month following fixation of a waist nonunion using cortico-cancellous graft from the iliac crest via the dorsal approach; B: Follow-up radiograph at two months revealing a sunken Herbert screw; C-G: Anteroposterior wrist radiograph and computed tomography slices at eight months showing union failure, graft resorption, and screw penetration into the scapho-trapezial joint.