• C Ramamurthy, L Cutler, D Nuttall, A J M Simison, I A Trail, and J K Stanley.
• University Hospital of North Staffordshire, 578 Newcastle Road, Stoke-on-Trent, ST4 6QG, UK. ramac@myway.com
• J Bone Joint Surg Br. 2007 May 1; 89 (5): 627-32.

AbstractThis study identified variables which influence the outcome of surgical management on 126 ununited scaphoid fractures managed by internal fixation and non-vascular bone grafting. The site of fracture was defined by a new method: the ratio of the length of the proximal fragment to the sum of the lengths of both fragments, calculated using specific views in the plain radiographs. Bone healing occurred in 71% (89) of cases. Only the site of nonunion (p = 1 x 10(-6)) and the delay to surgery (p = 0.001) remained significant on multivariate analysis. The effect of surgical delay on the probability of union increased as the fracture site moved proximally. A prediction model was produced by stepwise logistic regression analysis, enabling the surgeon to predict the success of surgery where the site of the nonunion and delay to surgery is known.

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