Patient-Related Factors Associated With Scaphoid Proximal Pole Avascular Necrosis Healing

Background: Avascular necrosis (AVN) of the proximal pole is a well-known complication of scaphoid fractures. Avascular necrosis is poorly understood, including the transition from ischemia to necrosis, optimal treatment, and why some AVN heals but others do not. The primary purpose of this study is to evaluate patient-related factors that are associated with healing outcomes in individuals with proximal pole AVN following scaphoid fractures. Methods: This is a retrospective review of all patients diagnosed with scaphoid proximal pole AVN secondary to a fracture from 2018 to 2024 in a single center. Patient baseline characteristics and comorbidities at time of diagnosis were collected. If the patient underwent surgical management, procedural factors were collected. The primary outcome was AVN healing after 4 months of follow-up. Results: A total of 62 patients met inclusion criteria. Thirty of 62 (48.4%) went onto proximal pole AVN resolution. Hyperlipidemia ( P = .030), advanced age at time of diagnosis ( P = .038), and elevated body mass index (BMI) ( P = .026) were independent factors associated with lack of AVN healing. For patients who underwent surgical management, there was no significant difference in healing outcomes between use of a nonvascularized, or no graft, and use of a vascularized bone flap ( P = .115, P = .886, respectively). Conclusions: Hyperlipidemia, elevated BMI, and advanced age are patient factors negatively associated with scaphoid proximal pole AVN healing—key information for accurately assessing patient prognosis. For surgical management, the choice of a vascularized bone, nonvascularized bone graft, or no graft does not significantly impact AVN healing.