Single Window Clearance Surgery for All Scaphoid Fracture Non Union-Experience of >30 Cases

Introduction 
Scaphoid nonunion presents a significant challenge for hand surgeons due to unpredictable outcomes. A range of treatment options, including iliac crest bone grafts, vascularized bone grafts, and medial femoral condylar bone grafts, have been documented, each with its own advantages and disadvantages.   

Materials and methods 
In this study, we share our experience treating 35 cases of scaphoid nonunion using a single volar incision approach for open reduction and internal fixation, supplemented by bone grafting from the distal radius, regardless of the fracture's location or avascular necrosis (AVN) status.  

Our core hypothesis posits that the surgical trauma and cortical osteotomy involved in harvesting the distal radius graft enhance vascular supply to the entire wrist region, thereby improving union rates, even in cases with proximal pole AVN. We believe that all scaphoid nonunions, excluding those with Scaphoid Nonunion Advanced Collapse (SNAC), should receive the same treatment, irrespective of MRI and CT findings; however, we remain open to ordering these investigations when necessary. 

Conclusion 
Among the 35 cases treated with our technique, all but one achieved successful union. Our preferred implant is a K-wire, which supports the simplicity and cost-effectiveness of this approach, leading to shorter hospitalization durations and improved union rates.