Purpose: The nonunion of the scaphoid is caused by various mistreatment of the scaphoid fracture, including long-term untreated or inadequately treated cases. We report our findings and discussions on postoperative outcomes and selection of surgical procedures in 47 cases including 13 cases of refractory scaphoid nonunion that required multiple operations. Materials and Methods: Those 47 cases included 44 males and 3 females with an age range of 15 to 65 at the time of operation (mean age: 27.8). Focal curettage and bone graft for the nonunion site were applied in 40 cases excluding 7 with scaphoid nonunion advanced collapse (SNAC) wrist. As the methods of bone graft, Russe procedure was applied in 4 cases and Herbert procedure was applied in the other 36 cases. As the internal fracture fixation materials, K-wires were used in 6 cases, Herbert screw in 8 cases, Bold screw in 5 cases, Whipple screw in 3 cases, and Acutrak mini screw in 18 cases. Meanwhile, the proximal part of the scaphoid was resected with tendon ball graft, 4-corner fusion, or modified Graner procedure was applied in the 7 cases with SNAC wrist. Postoperative follow-up periods were 2 to 10 years (mean: 4 years 7 months). Results: Bone union was observed in 28 out of 40 cases. The remaining 12 cases included the following: 5 cases which went untreated for at least 15 years, 3 with the application of Herbert-Whipple screw, 2 with the application of Bold screw, 1 with the inadequate insertion of Acutrak mini screw, and 1 with repeat nonunion caused by broken Acutrak screws. Revision surgery was conducted for the all cases: 1 with Russe procedure, 1 with Herbert procedure, and other 10 with vascularized bone graft procedure (2 with Zaidemberg procedure and 8 with the second metacarpal bone graft). As a result, bone union was observed in 10 cases. As the final treatment outcome, the ratio of grip strength of an operated hand to that of nonaffected hand was 50% to 114% (mean: 89%) and flexion-extension arc was 60° to 180° (mean: 121°). Conclusions: We had a satisfactory outcome for our treatment of the scaphoid nonunion. However, it should be noted that pedicle vascularized bone graft procedure needed to be applied to long-term untreated or repeat nonunion cases.
