Treatment of scaphoid proximal pole non-union with non-vascular cancellous bone grafting and headless compression screw fixation

Abstract

Objective: This study aimed to evaluate the radiological union rates and clinical functional outcomes of patients with scaphoid proximal pole non-union treated surgically with non-vascular cancellous bone grafting and headless compression screw fixation. The secondary objective was to examine whether magnetic resonance imaging (MRI) defined avascularity of the proximal pole is associated with union when the cortical shell of the proximal fragment is preserved on preoperative computed tomography (CT). Methods: This retrospective case series included patients treated for scaphoid proximal pole nonunion at a single tertiary hand surgery center between January 2018 and February 2025. Patients who underwent cancellous bone grafting and screw fixation and had adequate follow-up were included in the study. Preoperative evaluation was performed using wrist radiography, CT and, where available, MRI. Union was defined as greater than 50% bridging bone across the fracture site on CT at 12 weeks. Functional outcomes—wrist range of motion, grip strength, and lateral pinch strength—were assessed at final follow-up and expressed as a percentage of the contralateral, uninjured side. Results: Sixteen scaphoid proximal pole non-unions in 15 patients (14 male, 1 female; median age 19 years, range 14-44) were analyzed. The median injury-to-surgery interval was 8.5 months (range, 4-16) and the median follow-up was 9.0 months (range, 6-36). Preoperative MRI was performed in 13 scaphoids; findings suggestive of avascularity were present in 7 (53.8%). Bony union, confirmed on CT at 12 weeks, was achieved in 15 of 16 scaphoids (93.8%). The single non-union occurred in an adolescent patient. Expressed as a percentage of the contralateral side, the median values were 85.7% for wrist flexion, 91.3% for wrist extension, 89.4% for grip strength, and 95.3% for lateral pinch strength. No statistically significant differences in union rate or functional outcomes were found between adolescents and adults, between graft donor sites, or between scaphoids with and without MRI-defined avascularity. Conclusion: Non-vascular cancellous bone grafting combined with headless compression screw fixation provides high union rates and satisfactory functional outcomes in selected cases of scaphoid proximal pole non-union when the cortical shell and trabecular bone of the proximal fragment are preserved. Magnetic resonance maging–defined avascularity of the proximal pole did not appear to preclude union in this series.   Cite this article as: Erol K, Güntürk .B, Süğün TS, Ademoğlu Y. Treatment of scaphoid proximal pole non-union with non-vascular cancellous bone grafting and headless compression screw fixation. Acta Orthop Traumatol Turc. 2026; 60(5), 0912, doi: 10.5152/j.aott.2026.26912.