{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:42:32Z","timestamp":1784626952126,"version":"3.55.0"},"reference-count":55,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Scaphoid fractures are associated with high rates of late- or nonunion after conservative treatment. Nonunion is reported to occur in approximately 10% of all scaphoid fractures. It is known that the union of scaphoid fractures is affected by factors such as location at proximal pole, tobacco smoking, and the time from injury to treatment. Same factors seem to affect the healing after surgery for scaphoid nonunion. While the impact of preoperative humpback deformity on the functional outcome after surgery has been previously reported, the impact of humpback deformity, displacement, and the presence of bony cysts on union rate and time to healing after surgery has not been studied.<\/jats:p><jats:p>\n          Purpose\u2003The primary purpose of this study is to assess the association of humpback deformity, fragment displacement, and the size of cysts along the fracture line with the union rate and union time, following surgery of scaphoid nonunion. The second purpose of the study is to investigate the interobserver reliability in the evaluation of computed tomography (CT) scans of scaphoid nonunion.<\/jats:p><jats:p>\n          Patients and Methods\u2003From January 2008 to December 2018, 178 patients were surgically treated in our institution. After exclusion criteria were met, 63 patients with scaphoid delayed- or established nonunion, and preoperative CT scans of high quality (&lt;2mm.\/ slice), were retrospectively analyzed. There was 58 men and 5 women with a mean age of 30 years (range: 16\u201372 years). Four orthopaedic surgeons and one radiologist independently analyzed the CT scans. The dorsal cortical angle (DCA), lateral intrascaphoid angle (LISA), the height-to-length ratio, the size of the cysts, and displacement of the fragments were measured. Healing was defined by CT scan, or by conventional X-ray, and status of no pain at clinical examination. Thirty-two of the patients had developed nonunion (&gt;6 months postinjury), while 31 were in a stage of delayed union (3\u20136 months postinjury).<\/jats:p><jats:p>\n          Results\u2003Open surgery with cancellous or structural bone graft was the treatment of choice in 49 patients, 8 patients were treated with arthroscopic bone grafting, and 6 patients with delayed union were operated with percutaneous screw fixation, without bone graft. Overall union rate was 86% (54\/63) and was achieved after 84 days (12 weeks) (mean). The failure rate and time to healing were not associated with the degree of the humpback deformity, size of the cysts, or displacement of the nonunion in general. However, greater dislocation, and the localization of the nonunion at the scaphoid waist, showed significant influence on the union rate. Dislocation at nonunion site, in the group of the patients who united after surgery, was 2.7\u2009mm (95% confidence interval [CI]: 1.5\u20133.7), and in the group who did not unite was 4.2\u2009mm (95% CI: 2.9\u20135.7); p\u2009=\u20090.048). Time from injury to surgery was significantly correlated with time to union (p\u2009&lt;\u20090.05), but not associated with the union rate (p\u2009&lt;\u20090.4). Patients treated arthroscopically achieved faster healing (42 days), (standard deviation [SD]: 22.27) as compared with patients treated by open techniques (92 days; SD: 70.86). Agreement among five observers calculated as intraclass correlation coefficient was for LISA: 0.92; for height-to-length ratio: 0.73; for DCA: 0.65; for size of cysts: 0.61; and for displacement in millimeters: 0.24, respectively.<\/jats:p><jats:p>\n          Conclusions\u2003The degree of humpback deformity and the size of cysts along the fracture line of scaphoid nonunion have no predictive value for the result, neither for the union rate nor the union time after surgery for the scaphoid nonunion. However, larger dislocation of the fragments measured at the scaphoid waist showed lower union rate. Time to healing following surgery is mainly influenced by the time from injury to the surgical treatment and may be influenced by the choice of the surgical technique. Interrater reliability calculation was best with LISA measurements, and worse with the measurements of the dislocation.<\/jats:p><jats:p>\n          Level of Evidence\u2003This is a Level III, observational, case\u2013control study.<\/jats:p>","DOI":"10.1055\/s-0041-1730342","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T23:50:37Z","timestamp":1625269837000},"page":"418-429","source":"Crossref","is-referenced-by-count":11,"title":["Can CT-Scan Measurements of Humpback Deformity, Dislocation, and the Size of Bony Cysts Predict Union after Surgery for Scaphoid Nonunion?"],"prefix":"10.1055","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7150-2938","authenticated-orcid":false,"given":"Robert","family":"Gvozdenovic","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand Surgery Unit, Herlev\/Gentofte Copenhagen University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Presman","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hvidovre Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Bo","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand Surgery Unit, Herlev\/Gentofte Copenhagen University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitar Ivanov","family":"Radev","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bispebjerg\/Frederiksberg Copenhagen University Hospital, Copenhagen NV, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stig","family":"Joerring","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand Surgery Unit, Herlev\/Gentofte Copenhagen University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus Hjorth","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand Surgery Unit, Herlev\/Gentofte Copenhagen University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3109\/17453679209154827","article-title":"Epidemiology of scaphoid fractures in Odense, Denmark","volume":"63","author":"C F Larsen","year":"1992","journal-title":"Acta Orthop Scand"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1080\/02844319950159145","article-title":"Epidemiology of scaphoid fractures in Bergen, Norway","volume":"33","author":"L M Hove","year":"1999","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1055\/a-1250-8190","article-title":"Epidemiology of scaphoid fractures and non-unions: a systematic review","volume":"52","author":"P J\u00f8rgsholm","year":"2020","journal-title":"Handchir Mikrochir Plast Chir"},{"issue":"230","key":"ref4","first-page":"30","article-title":"Displaced fractures of the scaphoid","author":"R M Szabo","year":"1988","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.jhsa.2013.01.032","article-title":"Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively","volume":"38","author":"R Grewal","year":"2013","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1302\/0301-620X.73B5.1894676","article-title":"Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial","volume":"73","author":"N R Clay","year":"1991","journal-title":"J Bone Joint Surg Br"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"428","DOI":"10.2106\/00004623-198567030-00013","article-title":"The natural history of scaphoid non-union. A review of fifty-five cases","volume":"67","author":"L K Ruby","year":"1985","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0266-7681(90)90041-2","article-title":"Incidence of post-traumatic arthrosis after primary healing of scaphoid fractures: a clinical and radiological study","volume":"15","author":"G Lindstr\u00f6m","year":"1990","journal-title":"J Hand Surg [Br]"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF00453208","article-title":"The natural history of scaphoid non-union. Radiographical and clinical analysis in 102 cases","volume":"115","author":"G Inoue","year":"1996","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"759","DOI":"10.2106\/00004623-196042050-00002","article-title":"Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment","volume":"42-A","author":"O Russe","year":"1960","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/J.JHSB.2005.07.008","article-title":"In scaphoid non-union, does the source of graft affect outcome? Iliac crest versus distal end of radius bone graft","volume":"31","author":"A D Tambe","year":"2006","journal-title":"J Hand Surg [Br]"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/0363-5023(91)90017-6","article-title":"A new vascularized bone graft for scaphoid nonunion","volume":"16","author":"C Zaidemberg","year":"1991","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1053\/jhsu.2002.32077","article-title":"Use of the 1,2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion","volume":"27","author":"S P Steinmann","year":"2002","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1054\/jhsb.2002.0808","article-title":"Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery","volume":"27","author":"R G Straw","year":"2002","journal-title":"J Hand Surg [Br]"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jhsa.2005.10.019","article-title":"The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions","volume":"31","author":"M A Chang","year":"2006","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1177\/1753193408090400","article-title":"A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures","volume":"33","author":"J Braga-Silva","year":"2008","journal-title":"J Hand Surg Eur Vol"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.arthro.2010.05.015","article-title":"Arthroscopically assisted use of injectable bone graft substitutes for management of scaphoid nonunions","volume":"27","author":"P J Chu","year":"2011","journal-title":"Arthroscopy"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.hcl.2011.06.003","article-title":"Minimal invasive management of scaphoid fractures: from fresh to nonunion","volume":"27","author":"W Y Wong","year":"2011","journal-title":"Hand Clin"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.arthro.2014.08.035","article-title":"Arthroscopic management of chronic unstable scaphoid nonunions: effects on restoration of carpal alignment and recovery of wrist function","volume":"31","author":"J P Kim","year":"2015","journal-title":"Arthroscopy"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1007\/s11999-015-4495-3","article-title":"Is arthroscopic bone graft and fixation for scaphoid nonunions 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Altay","year":"2014","journal-title":"Int Orthop"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1142\/S242483551650034X","article-title":"Percutaneous fixation for scaphoid nonunion with bone grafting through the distal insertion hole of a fully threaded headless screw","volume":"21","author":"S Ohta","year":"2016","journal-title":"J Hand Surg Asian Pac Vol"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1055\/s-0036-1597681","article-title":"Percutaneous, transtrapezial fixation without bone graft leads to consolidation in selected cases of delayed union of the scaphoid waist","volume":"6","author":"M Vanhees","year":"2017","journal-title":"J Wrist Surg"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1302\/0301-620X.89B5.18183","article-title":"The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid","volume":"89","author":"C Ramamurthy","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"149","key":"ref30","first-page":"83","article-title":"Biomechanical implications of scaphoid waist fractures","author":"E R Weber","year":"1980","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.jhsa.2012.02.020","article-title":"Three-dimensional computed tomographic analysis of 11 scaphoid waist nonunions","volume":"37","author":"A Schweizer","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2106\/JBJS.16.00021","article-title":"Three-dimensional analysis of acute scaphoid fracture displacement: proximal extension deformity of the scaphoid","volume":"99","author":"Y Schwarcz","year":"2017","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref33","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":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1302\/0301-620X.73B1.1991749","article-title":"Scaphoid malunion","volume":"73","author":"P Nakamura","year":"1991","journal-title":"J Bone Joint Surg Br"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0363-5023(87)80067-9","article-title":"The effect of a simulated scaphoid malunion on wrist motion","volume":"12","author":"R C Burgess","year":"1987","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1177\/1558944716643295","article-title":"Long-term outcomes of scaphoid malunion","volume":"12","author":"B P Gillette","year":"2017","journal-title":"Hand (N Y)"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1302\/0301-620X.86B5.14374","article-title":"MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid","volume":"86","author":"M Bhat","year":"2004","journal-title":"J Bone Joint Surg Br"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s11552-013-9556-z","article-title":"Computed tomography for suspected scaphoid fractures: comparison of reformations in the plane of the wrist versus the long axis of the scaphoid","volume":"9","author":"W H Mallee","year":"2014","journal-title":"Hand (N Y)"},{"issue":"12","key":"ref39","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":"01","key":"ref40","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":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.jhsb.2005.05.007","article-title":"Partial union of acute scaphoid fractures","volume":"30","author":"H P Singh","year":"2005","journal-title":"J Hand Surg [Br]"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"T K Koo","year":"2016","journal-title":"J Chiropr Med"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00993","article-title":"Diagnostic performance of radiographs and computed tomography for displacement and instability of acute scaphoid waist fractures","author":"G A Buijze","year":"2012","journal-title":"J Bone Jt Surg - Ser A"},{"issue":"04","key":"ref44","first-page":"244","article-title":"Correlation of reconstructed scaphoid morphology with clinical outcomes","volume":"3","author":"A Afshar","year":"2015","journal-title":"Arch Bone Jt Surg"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199274080-00012","article-title":"Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid","author":"W A Jiranek","year":"1992","journal-title":"J Bone Jt Surg - Ser A"},{"issue":"01","key":"ref46","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":"01","key":"ref47","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00590-016-1886-4","article-title":"Prognostic factors in the treatment of carpal scaphoid non-unions","volume":"27","author":"F Schuind","year":"2017","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"03","key":"ref48","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.otsr.2014.09.026","article-title":"Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: a 5-year minimum follow-up study","volume":"101","author":"C H Lee","year":"2015","journal-title":"Orthop Traumatol Surg Res"},{"issue":"01","key":"ref49","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 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