Reoperation and Complication Rates Following Percutaneous Bone Graft and Headless Screw Fixation for Scaphoid Non-union: A 10-Year, Single-Centre Experience

Background and objectivePercutaneous fixation techniques have been recommended for certain scaphoid non-unions as they limit soft tissue disruption and may help preserve scaphoid vascularity.Adding percutaneous bone grafting aims to improve biological healing while keeping the approach minimally invasive.However, the evidence on outcomes is still limited.This study evaluated the radiographic and clinical outcomes of percutaneous bone grafting combined with screw fixation for the treatment of scaphoid non-union. MethodsA retrospective review was conducted involving all patients who underwent percutaneous iliac crest bone grafting and headless compression screw fixation for scaphoid non-union by a single surgeon at a single institution between 2010 and 2020.Demographic data, fracture characteristics, union status, complications, and reoperations were documented. ResultsThe study included 45 consecutive patients with accessible clinical records.The mean age was 26.3 ± 11.2 years (range: 16-63 years), and 41 (91%) were male.The scaphoid waist was involved in most non-unions (41/45, 91%), while four affected the proximal pole.Patients were followed for a mean of 591.9 ± 508.1 days (median: 502 days; interquartile range (IQR): 216-653.5 days).Radiographic union was observed in 15 patients, with a mean time to first documented union of 115.5 ± 41.4 days (range: 41-202 days).Persistent non-union was documented during follow-up in 26 patients; however, 10 of these did not complete later imaging surveillance, which precluded definitive determination of final union status.At least one postoperative complication occurred in 17 patients (37.8%).Hardware-related complications predominated, with screw loosening in 13 patients and painful screw malposition in one.Other complications comprised persistent pain (6.7%), wrist stiffness (4.4%), symptomatic non-union (6.7%), infection (2.2%), and progression to scaphoid non-union advanced collapse (SNAC) wrist (2.2%).Reoperation was performed in 16 patients (35.6%; 95% confidence interval (CI): 23.2-50.2%),most commonly for screw removal (n = 13).Three patients went on to have vascularised bone grafting, and one underwent wound washout with concurrent screw removal for infection.Among 15 patients with a documented reoperation date, the mean time to reoperation was 404.3 days (median: 308 days; IQR: 207.5-448.5 days). ConclusionsPercutaneous bone grafting and screw fixation for scaphoid non-union was associated with a substantial complication burden and a high reoperation rate.Although minimally invasive techniques offer theoretical biological advantages, careful patient selection is essential.Further comparative studies are required to establish the role of this technique relative to established open reconstructive methods.