Treatment of non-union scaphoid fractures by Kirschner wires and ipsilateral distal radius bone grafts: a case series.

Background: Non-union scaphoid fractures are a hazard to the wrist because of the increasing risk of avascular necrosis and degenerative changes. We managed non-union scaphoid fractures by open reduction, Kirschner (K)-wire fixation, and bone graft from distal radius. Methods: This retrospective case series included seven patients with missed, established cases of non-union scaphoid fractures diagnosed by imaging at a tertiary care center between 2015 and 2017 in Nepal. All patients were treated with open reduction, K-wire fixation, and ipsilateral distal radius bone grafting. The patients were followed up at one, two, three, six and eight month post-surgery with imaging and at six and eight months with the modified Mayo wrist score (MMWS). Results: The mean duration of treatment time after the primary injury was 7 months. All the cases were males and the mean age of patients at surgery was 27 (range = 17-46) years. The mean duration of radiological and clinical evidence of healing was 4.3 months. The radiological healing was confirmed in all treated patients. All of the patients had improved outcomes in wrist function as indicated by improvement in MMWS at six and eight months. Conclusion: Our case series showed that the standard method using open reduction, K-wire fixation, and ipsilateral distal radius bone grafting is a reliable and cost-effective procedure for most untreated and non-union scaphoid fractures.