Scaphoid non-union with humpback deformity is commonly managed with volar structural bone grafting. This meta-analysis compares outcomes of distal radius bone graft (DRBG) versus iliac crest bone graft (ICBG).

Following PRISMA guidelines (PROSPERO CRD420251106177), MEDLINE, Embase, ClinicalTrials, and SPORTDiscus were searched to March 1, 2026. Comparative adult studies of scaphoid non-union with humpback deformity treated via volar DRBG or ICBG with headless compression screw fixation were included. Primary analysis pooled vascularized and non-vascularized grafts; subgroup analysis compared non-vascularized grafts.

Three studies (166 patients; 73 DRBG, 93 ICBG) were included. No statistically significant difference was detected between the union rates reported across the included studies (DRBG: 87–100%; ICBG: 79–96%) (P = 0.33). Time to union favored DRBG by a mean of 1.02 weeks (P = 0.006), although the magnitude of this difference is unlikely to be clinically meaningful. Grip strength, pinch strength, and range of motion showed no significant differences (P ≥ 0.42). In the non-vascularized subgroup (2 studies, 126 patients), union remained similar (P = 0.64) while Mayo Wrist Score favored DRBG (MD = 3.45; P = 0.03). ICBG had higher donor-site morbidity, specifically persistent pain and hematomas (20% vs. 0%). Certainty of evidence was very low.

DRBG and ICBG showed no detectable differences in union or most functional outcomes. DRBG may be associated with lower donor-site morbidity; however, this observation was based on two studies and could not be quantitatively pooled. Although time to union and subgroup functional outcomes favored DRBG, findings are based on very low certainty evidence and limited data, may lack clinical significance, and warrant caution.