title: Long-term results of scaphoid nonunion surgery:  50 patients reviewed after 8 to 18 years.
abstract: OBJECTIVE
  Untreated scaphoid nonunions are a hazard to the wrist, resulting in deteriorating function and radiologic degenerative changes with increasing time. Long-term results after surgery of scaphoid nonunion reporting clinical, radiologic, and subjective outcomes are scarce.
  
  
  METHODS
  Retrospective follow-up study.
  
  
  METHODS
  From 1990 to 1998, 53 patients were operated on for persistent scaphoid nonunion; three patients were excluded from the follow-up (one expelled foreigner, another died of an unrelated cause, one never appeared after surgery), leaving 50 patients eligible for follow-up.
  
  
  METHODS
  All patients were operated on with open reduction and internal fixation; the majority also received a bone graft.
  
  
  METHODS
  Radiology and computed tomography verified union, degenerative wrist changes, and final salvage treatment. Range of motion, grip strength, key pinch, and subjective outcome (QuickDASH, visual analog scale).
  
  
  RESULTS
  Fifty patients were followed up after a mean of 12.2 years (standard deviation [SD], 3.0), 47 by clinical and radiologic examination; three were interviewed by telephone and completed QuickDASH and visual analog scale forms. Union was achieved in 45 of 50 scaphoids and an additional two after a second attempt. Five patients (one persistent and four healed nonunions) underwent salvage procedures. Grip strength (41 vs 45 kg, P = nonsignificant), key pinch (11.5 vs 12.4, P = nonsignificant), and active range of motion (186° vs 214°, P < 0.001) were slightly reduced compared with the uninjured side. The subjective outcome was good (mean visual analog scale = 7, mean QuickDASH = 9.1). Minor degenerative changes were seen in nine wrists at surgery and 22 at follow-up.
  
  
  CONCLUSIONS
  Healing of a scaphoid nonunion provides long-term pain relief, excellent wrist function, and halts degenerative changes in the majority of patients.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Hand and Microsurgery Section, Orthopaedic Department, Oslo University Hospital-Rikshospitalet, Oslo, Norway. ole.reigstad@gmail.com
authors.forename: Ole
authors.initials: O
authors.lastname: Reigstad
authors.forename: Christian
authors.initials: C
authors.lastname: Grimsgaard
authors.forename: Rasmus
authors.initials: R
authors.lastname: Thorkildsen
authors.forename: Astor
authors.initials: A
authors.lastname: Reigstad
authors.forename: Magne
authors.initials: M
authors.lastname: Rokkum
mesh_terms: D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000601:surgery*; D017759:Fractures, Malunited / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult