{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:01:02Z","timestamp":1790290862813,"version":"4.1.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Scaphoid nonunion can progress to wrist pain, stiffness and an established pattern of wrist arthritis. The effect of scaphoid malunion on clinical outcomes is largely unknown. In this study, the effect of scaphoid morphology on union rates and clinical outcomes is explored using a prospectively collected database of surgeries.<\/jats:p>\n                  <jats:p>The primary aim of the study is to understand the effect of initial post-surgical scaphoid morphology on union. The secondary aim examines the effect of final scaphoid morphology on long-term functional outcomes among patients that underwent surgical fixation for scaphoid nonunion and ultimately went on to union.<\/jats:p>\n                  <jats:p>84 participants were included in this study. 74 (88.1%) nonunions went to union, and 10 (11.9%) remained persistent nonunions after surgery.<\/jats:p>\n                  <jats:p>After nonunion surgery, the initial post-operative height-to-length (H\/L) ratio was predictive of scaphoid union. For every 0.1 increase in H\/L ratio, odds of union were reduced by 53.7%. Of the patients who progressed to union, there was a significant relationship (p=0.019) between initial post-operative H\/L ratio and final DASH scores. It was found that there was a 35.9% increase in DASH score for every 0.1 increase in H\/L ratio. Similarly, there was a significant relationship (p=0.013) between final post-operative H\/L ratio and final DASH scores where an increase of 0.l in H\/L ratio translated to a 33.5% increase in DASH.<\/jats:p>\n                  <jats:p>The authors propose that the restoration of initial post-operative H\/L ratio can predict odds of union after surgical fixation of an established scaphoid nonunion. Improved morphology at union as measured by H\/L ratio also demonstrated improved functional outcomes, such as DASH score.<\/jats:p>","DOI":"10.1055\/a-2745-8232","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:17:26Z","timestamp":1764807446000},"page":"452-458","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Scaphoid Morphology After Surgical Fixation of Scaphoid Nonunions on Long-term Functional Outcomes and Scaphoid Union Rates"],"prefix":"10.1055","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-9966","authenticated-orcid":false,"given":"Isabelle E.L.","family":"Tottenham","sequence":"additional","affiliation":[{"name":"Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany K.","family":"Coromina","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Makati Medical Center, Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurpreet","family":"Dhaliwal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Sayre","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibo","family":"Li","sequence":"additional","affiliation":[{"name":"Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada"},{"name":"Western Hand & Upper Limb Facility, Sturgeon Hospital, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"e162775","DOI":"10.1001\/jamasurg.2016.2775","article-title":"Epidemiology of fracture nonunion in 18 human bones","volume":"151","author":"R Zura","year":"2016","journal-title":"JAMA Surg"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.surge.2012.03.004","article-title":"Acute fractures of the scaphoid bone: systematic review and meta-analysis","volume":"10","author":"S Alshryda","year":"2012","journal-title":"Surgeon"},{"issue":"09","key":"ref3","first-page":"548","article-title":"Management of nonunion following surgical management of scaphoid fractures: current concepts","volume":"21","author":"E S Moon","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1302\/0301-620X.71B2.2925752","article-title":"Patterns of union in fractures of the waist of the scaphoid","volume":"71","author":"J J Dias","year":"1989","journal-title":"J Bone Joint Surg Br"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1055\/s-0043-1760753","article-title":"Scaphoid length loss following nonunion is associated with dorsal intercalated segment instability","volume":"12","author":"A EJ Bulstra","year":"2023","journal-title":"J Wrist Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jcot.2020.05.022","article-title":"Management of chronic scapholunate ligament injury","volume":"11","author":"K Wahed","year":"2020","journal-title":"J Clin Orthop Trauma"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/1753193417739526","article-title":"Treatment of the scaphoid humpback deformity\u2014is correction of the dorsal intercalated segment instability deformity critical?","volume":"43","author":"C L Mathoulin","year":"2018","journal-title":"J Hand Surg Eur Vol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/0363-5023(89)90191-3","article-title":"Scaphoid malunion","volume":"14","author":"P C Amadio","year":"1989","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.injury.2011.08.015","article-title":"Scaphoid morphology and clinical outcomes in scaphoid reconstructions","volume":"43","author":"K Megerle","year":"2012","journal-title":"Injury"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"883.e1","DOI":"10.1016\/j.jhsa.2020.04.002","article-title":"Scaphoid malunion clinical and radiographic outcomes at a minimum of 4 years follow-up","volume":"45","author":"A Seltser","year":"2020","journal-title":"J Hand Surg Am"},{"issue":"17","key":"ref11","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.2106\/JBJS.23.00783","article-title":"Low-intensity pulsed ultrasound versus sham in the treatment of operatively managed scaphoid nonunions: the SNAPU randomized controlled trial","volume":"106","author":"N J White","year":"2024","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.jhsa.2012.03.002","article-title":"Management of scaphoid nonunion","volume":"37","author":"G A Buijze","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0363-5023(98)80093-2","article-title":"Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques","volume":"23","author":"G I Bain","year":"1998","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"112067","DOI":"10.1016\/j.injury.2024.112067","article-title":"An endpoint adjudication committee for the assessment of computed tomography scans in fracture healing","volume":"56","author":"C Elliott","year":"2025","journal-title":"Injury"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jhsa.2014.10.037","article-title":"Quantifying scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography","volume":"40","author":"P W ten Berg","year":"2015","journal-title":"J Hand Surg Am"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"38S","DOI":"10.1177\/15589447211038678","article-title":"How is scaphoid malunion defined: a systematic review","volume":"18","author":"M Xiao","year":"2023","journal-title":"Hand (N Y)"},{"issue":"12","key":"ref17","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.jhsa.2018.05.006","article-title":"The effect of computed tomography scans oriented along the longitudinal scaphoid axis on measurements of deformity and displacement in scaphoid fractures","volume":"43","author":"A N Cheema","year":"2018","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"102980","DOI":"10.1016\/j.otsr.2021.102980","article-title":"The effect of reformatting axis of computed tomography scans on the measurement of deformities in scaphoid waist nonunion","volume":"107","author":"G B Lee","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/1753193408093327","article-title":"The clinical outcome of scaphoid fracture malunion at 1 year","volume":"34","author":"D P Forward","year":"2009","journal-title":"J Hand Surg Eur Vol"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1055\/s-0041-1730342","article-title":"Can CT-scan measurements of humpback deformity, dislocation, and the size of bony cysts predict union after surgery for scaphoid nonunion?","volume":"10","author":"R Gvozdenovic","year":"2021","journal-title":"J Wrist Surg"}],"container-title":["Journal of Wrist Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2745-8232.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:46:22Z","timestamp":1790289982000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2745-8232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":20,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,9,24]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2745-8232","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2163-3916","2163-3924"],"issn-type":[{"value":"2163-3916","type":"print"},{"value":"2163-3924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}