Long-term outcomes following scaphoid nonunion surgery: the role of structural severity, avascular necrosis, and surgical timing.
4 affiliations
- 1Department of Orthopaedics and Traumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun-Türkiye.
- 2Department of Orthopaedics and Traumatology, Amasya Şerefeddin Sabuncuoğlu Training and Research Hospital, Amasya-Türkiye.
- 3Department of Orthotics and Prosthetics, Ondokuz Mayıs University Faculty of Health Sciences, Samsun-Türkiye.
- 4Department of Orthopaedics and Traumatology, Samsun Training and Research Hospital, Samsun-Türkiye.
Abstract
Background
This study aimed to evaluate the long-term clinical and radiological outcomes of patients undergoing surgical treatment for scaphoid nonunion and to examine the independent effects of surgical timing and preoperative avascular necrosis (AVN) on postoperative recovery.Methods
This retrospective cohort study included 71 adult patients who underwent surgical treatment for scaphoid nonunion between 2011 and 2020 and had a minimum follow-up of five years. Variables included demographic characteristics, surgical timing, pre-operative AVN, and radiographic severity. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Wrist Evaluation (PRWE), and Mayo Wrist Score (MWS). Radiological evaluation included scaphoid nonunion advanced collapse (SNAC) staging, scapholunate angle (SLA), radiolunate angle (RLA), and carpal height index. Multivariate linear and logistic regression analyses were performed to identify independent predictors of functional improvement, union, complications, and reoperation.Results
The mean patient age was 34.4±7.1 years, and the mean follow-up duration was 78.4±10.3 months. Preoperative AVN was present in 29.6% of patients. Union was achieved in 76.1% of patients, while complication and reoperation rates were 26.8% and 18.3%, respectively. In univariate analysis, surgery performed within 12 months of injury was associated with greater improvement in resting pain (p=0.046), and the absence of AVN was associated with greater improvement in pain scores and MWS (p<0.05). After adjustment for baseline pain and radiographic severity, surgical timing was no longer independently associated with pain improvement (p=0.056), whereas AVN remained an independent predictor of reduced symptomatic recovery (p<0.001). No variable independently predicted union. The preoperative SNAC stage was associated with complications (p=0.007), and Schernberg classification predicted reoperation (p=0.011). Radiographic parameters were not associated with functional outcomes. These findings suggest that biological and structural disease burden may have a greater influence on long-term recovery than surgical timing alone. Although vascular compromise appears to limit symptomatic improvement despite surgical intervention, structural severity influences the risk of adverse postoperative events. The absence of a correlation between radiographic healing and functional outcomes underscores the complex and multifactorial nature of recovery after scaphoid nonunion surgery.Conclusion
Surgical timing and radiographic union were not independently associated with long-term functional recovery. In contrast, preoperative AVN predicted less symptomatic improvement, whereas structural severity, reflected by SNAC stage and Schernberg classification, was associated with postoperative complications and reoperation.
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BibTeX
@article{erdogan2026longterm,
title = {{Long-term outcomes following scaphoid nonunion surgery: the role of structural severity, avascular necrosis, and surgical timing.}},
author = {Furkan Erdogan and Emre Calisal and Mine Pekesen Kurtca and Bedirhan Albayrak and Ahmet Piskin},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma \& emergency surgery : TJTES},
year = {2026},
month = oct,
doi = {10.14744/tjtes.2026.99600},
url = {https://europepmc.org/article/MED/42841900},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Long-term outcomes following scaphoid nonunion surgery: the role of structural severity, avascular necrosis, and surgical timing.
AU - Furkan Erdogan
AU - Emre Calisal
AU - Mine Pekesen Kurtca
AU - Bedirhan Albayrak
AU - Ahmet Piskin
PY - 2026
DA - 2026/10/01
JO - Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES
DO - 10.14744/tjtes.2026.99600
UR - https://europepmc.org/article/MED/42841900
AB - Background This study aimed to evaluate the long-term clinical and radiological outcomes of patients undergoing surgical treatment for scaphoid nonunion and to examine the independent effects of surgical timing and preoperative avascular necrosis (AVN) on postoperative recovery.Methods This retrospective cohort study included 71 adult patients who underwent surgical treatment for scaphoid nonunion between 2011 and 2020 and had a minimum follow-up of five years. Variables included demographic characteristics, surgical timing, pre-operative AVN, and radiographic severity. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Wrist Evaluation (PRWE), and Mayo Wrist Score (MWS). Radiological evaluation included scaphoid nonunion advanced collapse (SNAC) staging, scapholunate angle (SLA), radiolunate angle (RLA), and carpal height index. Multivariate linear and logistic regression analyses were performed to identify independent predictors of functional improvement, union, complications, and reoperation.Results The mean patient age was 34.4±7.1 years, and the mean follow-up duration was 78.4±10.3 months. Preoperative AVN was present in 29.6% of patients. Union was achieved in 76.1% of patients, while complication and reoperation rates were 26.8% and 18.3%, respectively. In univariate analysis, surgery performed within 12 months of injury was associated with greater improvement in resting pain (p=0.046), and the absence of AVN was associated with greater improvement in pain scores and MWS (p<0.05). After adjustment for baseline pain and radiographic severity, surgical timing was no longer independently associated with pain improvement (p=0.056), whereas AVN remained an independent predictor of reduced symptomatic recovery (p<0.001). No variable independently predicted union. The preoperative SNAC stage was associated with complications (p=0.007), and Schernberg classification predicted reoperation (p=0.011). Radiographic parameters were not associated with functional outcomes. These findings suggest that biological and structural disease burden may have a greater influence on long-term recovery than surgical timing alone. Although vascular compromise appears to limit symptomatic improvement despite surgical intervention, structural severity influences the risk of adverse postoperative events. The absence of a correlation between radiographic healing and functional outcomes underscores the complex and multifactorial nature of recovery after scaphoid nonunion surgery.Conclusion Surgical timing and radiographic union were not independently associated with long-term functional recovery. In contrast, preoperative AVN predicted less symptomatic improvement, whereas structural severity, reflected by SNAC stage and Schernberg classification, was associated with postoperative complications and reoperation.
SN - 1306-696X
SN - 1307-7945
ER -