Treatment of scaphoid fracture non-union: a systematic review of the current evidence

Abstract

Fractures of the scaphoid are susceptible to consequences including non-union, delayed union, malunion, and avascular necrosis. The treatment of non-union of the scaphoid remains contentious, and there is no consensus regarding the appropriate management strategy. This systematic review\'s main objective was to examine the current data for the management of scaphoid non-union. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the common practices in the field. Eligible articles were identified by a search of OVID-MEDLINE, PubMed, and EMBASE for the period of 1st January, 2000 up to 30th April, 2023. A through database searching resulted in a total of 786 entries, of which 156 were from EMBASE, 118 from OVID-MEDLINE, and 512 from PUBMED. After duplicate records were eliminated, 165 records were checked for eligibility and 147 of these were disregarded for a variety of reasons, including animal studies (n=16), not related to the topic (n=63), and the outcome was not presented (n=68). The eligibility of the remaining 18 full-text publications was evaluated. Eighteen articles passed the inclusion tests and were added to the research after a thorough evaluation. Scaphoid fractures and nonunion required careful examination of therapeutic options. Bone grafting procedures, such as arthroscopic fixation with bone grafting and the Fisk-Fernandez approach, had excellent outcomes. Ultrasonic treatment is also needed, but evidence is limited.