The authors performed a retrospective study comparing the effectiveness of distal radius and iliac crest bone grafts in treating scaphoid fracture nonunions. An iliac crest graft was used in 44 cases and a distal radius graft was used in 24 cases, with comparable methods of fixation. The minimum radiographic follow-up was 8 months. The rates of restoration of carpal anatomy and scaphoid union (approximately 66%) were similar between groups, but with persistent donor site pain in 5 iliac crest harvest cases at 6 months.
Achieving bone union and restoring scaphoid bone architecture are important goals in treating scaphoid fracture nonunions. There has been basic science evidence to suggest greater osteogenic potential of iliac crest bone graft when compared to the distal radius. However, harvest of this graft clearly increases surgical morbidity. This study lends support to the effectiveness of distal radius bone graft and although not prospective and randomized, shows little clininal benefit in using the hip as a donor site in these cases.
Scaphoid, Non-union, Bone, Graft, Radius, Iliac, Crest
Journal of Hand Surgery