The natural history of scaphoid non-union.

TLDR

We reviewed clinical and radiographic data from 47 scaphoid non‑unions in 46 symptomatic patients to assess the incidence and severity of wrist degenerative changes. Among 47 scaphoid non‑unions, 23 showed isolated scaphoid sclerosis/cyst/resorption (Group I), 14 had radioscaphoid arthritis (Group II), and 10 had generalized wrist arthritis (Group III); the average duration of non‑union increased from 8.2 years in Group I to 31.6 years in Group III, with fracture displacement and carpal instability—evidenced by ≥10° lunate dorsiflexion—correlating with severity, leading the authors to recommend early reduction and grafting of displaced fractures and counseling asymptomatic stable non‑unions about potential late degeneration.

Abstract

We reviewed the clinical and roentgenographic findings of forty-seven non-unions of a fracture of the scaphoid in forty-six symptomatic patients in order to assess the incidence and severity of degenerative changes of the wrist. The duration of non-union ranged from five to fifty-three years. Three roentgenographic patterns were seen: twenty-three lesions had sclerosis, cyst formation, or resorptive changes confined to the scaphoid bone (Group I); fourteen had radioscaphoid arthritis (Group II); and ten had generalized arthritis of the wrist (Group III). The duration of Group-I non-unions averaged 8.2 years; Group-II, 17.0 years; and Group-III non-unions, 31.6 years. Fracture displacement and carpal instability correlated with the severity of degenerative changes. Lunate dorsiflexion of 10 degrees or more was a useful guide to carpal instability. Few of the forty-seven non-unions were undisplaced, stable, or free of arthritis after ten years. Based on the high probability of arthritis, we recommend that all displaced ununited scaphoid fractures be reduced and grafted, regardless of symptoms, before degenerative changes occur. Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.