Comparative efficacy of non-vascularized and vascularized bone grafts, with emerging insights into bone biomaterial grafts, in scaphoid fracture nonunion treatment: A systematic review and meta-analysis

Background

Scaphoid fractures are prevalent wrist injuries with significant treatment challenges, especially when get complicated by nonunion and avascular necrosis. Various grafting techniques, including non-vascularized bone grafts (NVBGs), vascularized bone grafts (VBGs), and bone biomaterial grafts, are utilized to promote healing, but the comparative efficacy of these methods remains unclear.

Objective

This systematic review and meta-analysis aim to assess the efficacy of different types of bone grafts (NVBGs, VBGs, and bone biomaterials) in the treatment of scaphoid nonunion, focusing on outcomes including union rates, time to healing, and functional recovery scores.

Methods

A systematic search of PubMed, Scopus, Cochrane and Web of Science was conducted to identify eligible studies published between 2000 and 2024. studies were categorized into: (1) comparative studies of NVBG vs. VBG, (2) studies reporting only NVBG outcomes, and (3) studies reporting only VBG outcomes. Bone Biomaterials were assessed separately due to limited data (one study). Meta-analyses were performed on in common reported outcomes for each group including union rates, time to healing, range of motion, grip strength, and Modified Mayo Wrist Scores (MMWS).

Results

A total of 62 studies involving 2332 scaphoid nonunion patients were included. VBGs demonstrated significantly higher union rates and shorter healing times compared to NVBGs. VBG-treated patients also showed better functional outcomes, including greater grip strength and MMWS in comparative studies NVBGs were less effective in evaluated cases and required longer healing times. The use of bone biomaterial grafts, although limited in the current literature, showed promising results comparable to NVBGs, but further studies are needed.

Conclusion

VBGs demonstrated higher union rates and shorter healing times compared to NVBGs, with better functional outcomes in some cases, though evidence certainty is moderate. Bone biomaterials represent a promising alternative to traditional grafts but require more evidence to support their widespread use. Treatment decision-makers should consider clinical context and case-specific conditions. Further research is needed to confirm these trends.

Translational potential: This study helps clinical decision-making by evaluating the efficacies of different bone grafts outcomes in complex scaphoid nonunions, potentially reducing treatment failures. It also underscores the emerging role of bone biomaterial grafts as a less invasive alternative, paving the way for personalized orthopedic strategies needing further evaluations to be used for treating scaphoid nonunions.