Cannulated Screw Fixation for Scaphoid Nonunion Without Bone Grafting

INTRODUCTION: This study aimed to evaluate radiological union and clinical outcomes of patients with Slade Grade III–IV scaphoid nonunion treated with open reduction and internal fixation using a cannulated compression screw without autologous bone grafting.
METHODS: A retrospective cohort of patients who underwent first-time surgery for Grade III–IV scaphoid nonunion between January 2017 and May 2024 was reviewed. Union was assessed radiographically, and clinical outcomes were evaluated using the Mayo Wrist Score.
RESULTS: Twenty-two patients (20 men, 2 women; mean age 28 years, range 18–41) were included. Union was achieved in all patients, with a mean union time of 17 weeks. The median Mayo Wrist Score improved from 70.5 preoperatively to 90.5 at 12 months. Outcomes were excellent in 13 (59.1%), good in 6 (27.3%), and fair in 3 (13.6%) patients.
DISCUSSION AND CONCLUSION: Open reduction and cannulated screw fixation without bone grafting may be an effective option for selected patients with Slade Grade III–IV scaphoid nonunion.

Keywords: Scaphoid, Nonunion, Fracture Fixation, Osteosynthesis, Wrist