Factors Associated with Re-operation after Surgery for Scaphoid Nonunion: Level 4 Evidence

Abstract

Hypothesis: To determine the rate of unplanned reoperation after surgery for scaphoid nonunion, the reasons for unplanned reoperation, and factors associated with unplanned reoperation. Methods: Using an institutional database, we identified 190 patients that had surgery for a scaphoid non-union from 2000 to 2013. There were 172men and 18 women with an average age of 26 11 years (Range, 16 to 84 years). The result of the surgerywas categorized as follows: no unplanned reoperation and healed fracture; unplanned reoperation for any reason; unplanned repeat surgery recommended but not done; and unknown status. We tested age, sex, affected side, interval between injury and operation, operation duration, fracture location, dorsal intercalated segment instability, surgeonperception of avascular necrosis of proximal pole, fixation device, type of bone graft, surgeon, and operative approach for association with unplanned repeat surgery. Results: After the index operation to treat scaphoid non-union in 190 wrists, 100 (53%) had no unplanned reoperation and healed; 39 (21%) had an unplanned reoperation; in 34 (18%) unplanned repeat surgery was recommended but not done; and in 17 the status was unknown (9%). After all subsequent surgeries, 110 patients (58%) healed (10 after one or more subsequent surgeries), 49 (26%) had persistent nonunion, 5 (3%) had a salvage procedure (e.g. excision of the distal pole of the scaphoid), and the status of 26 patients was unknown (14%). The indication for surgery in all 73 patients who had unplanned reoperation or recommended unplanned reoperation was persistent nonunion. In bivariate and multivariable analysis, the only factor related to reoperation was Kirschner wire rather than compression screw fixation of the scaphoid. Summary Points: Persistent nonunion is common after surgery for scaphoid non-union. Surgeries for persistent nonunion is even less successful.