Introduction: Scaphoid waist nonunion with avascular necrosis is a difficult reconstructive problem because impaired blood supply, instability, and deformity can compromise healing and function. Vascularized grafting has therefore emerged as a biologically appealing option to improve union in selected patients. The aim of this study was to evaluate the early outcomes of the Mathoulin technique in scaphoid waist nonunion with avascular necrosis.

Material and methods: This descriptive cross-sectional study was conducted at Shahid Madani Hospital, Tabriz, with a convenience sample of 50 eligible patients selected using the standard descriptive sample-size formula. Patients underwent evaluation and treatment with the Mathoulin technique, and demographic, clinical, radiographic, and early postoperative outcome variables were recorded to assess short-term surgical results.

Results: The cohort comprised 50 patients (mean age 34.8±9.6 years), predominantly men (64.0%), with avascular necrosis in all cases and a mean nonunion duration of 15.2±6.4 months. After the Mathoulin technique, pain, wrist motion, and grip strength improved significantly (VAS 6.9±1.2 to 2.1 1.0; flexion 41.3±8.7° to 55.6±7.9°; grip strength 19.4±5.3 to 28.7±6.1 kg; all P<0.001), and union was achieved in 88.0% of patients at 11.8±2.6 weeks. Smoking, prior surgery, longer nonunion, severe AVN, and humpback deformity were associated with poorer outcomes.

Conclusion: The Mathoulin technique provided encouraging early clinical and radiographic results for scaphoid waist nonunion with avascular necrosis, with high union rates and significant functional improvement. Outcomes were less favorable in patients with smoking, prior surgery, prolonged nonunion, severe AVN, or deformity, suggesting that careful patient selection remains important.