Scaphoid Bone Grafting (Non-Union)

⚙️What This Procedure Involves

An incision is made on the front (volar) or back (dorsal) of the wrist. The non-union site is exposed, the fibrous tissue is removed, and the bone ends are freshened. A bone graft (usually from the distal radius or iliac crest) is shaped and placed into the defect. A headless compression screw is inserted to stabilise the construct. For proximal pole non-unions with AVN, a vascularised bone graft (from the distal radius with its blood supply intact) may be used. The operation takes one to two hours.

💡Why It May Be Recommended

Surgery is recommended for established scaphoid non-union to prevent progressive wrist arthritis (SNAC wrist). Without treatment, the abnormal mechanics of the non-united scaphoid lead to predictable arthritis over years.

⚖️Non-Operative Alternatives

Observation may be appropriate in asymptomatic patients with minimal arthritis. However, non-unions do not heal spontaneously and arthritis will progress over time.

📋Preparing for Surgery

CT scan to assess the non-union and any cyst formation. MRI to assess vascularity of the proximal pole. X-rays for staging of any arthritis.

✅Expected Benefits

Union rates for scaphoid bone grafting are approximately 80–90% for waist non-unions. Proximal pole non-unions with AVN have lower healing rates (60–70%) even with vascularised graft. Successful union prevents arthritis progression.

⚠️Common Risks

• Persistent non-unionUncommon

  The scaphoid may still fail to heal despite grafting. Risk approximately 10-20%.

• Wrist stiffnessCommon

  Some loss of wrist motion.

• Graft site painCommon

  If bone was harvested from the iliac crest.

🔴Less Common but Serious Risks

• AVN progressionUncommon

  The proximal pole may continue to lose blood supply.

• Screw complicationsUncommon

  Screw prominence or migration.

• InfectionRare

  Wound or bone infection.

• SNAC arthritisLong-term

  Despite successful union, some arthritis may already be present.

💉Anaesthetic Considerations

General or regional anaesthesia.

🏃Recovery and Rehabilitation

Cast for six to eight weeks. CT scan at three months to assess union. Hand therapy for wrist movement and grip strength. Full recovery three to six months.

📅Follow-Up

X-ray at six weeks. CT at three months to confirm union.

❓Frequently Asked Questions