Background
Nonunion of the fractured scaphoid is a difficult surgical problem. This condition may occur in 5-10% of scaphoid fractures treated nonoperatively. Its occurrence has been attributed to delayed diagnosis and treatment, inadequate immobilization, displacement, or instability secondary to ligamentous injury. Moreover, the incidence of nonunion is greater in proximal pole fractures in which the vascularity of the proximal fracture segment is compromised. Numerous techniques have been described for the treatment of patients with scaphoid nonunions, with success rates varying from ∼70 to 90%. The generally accepted surgical treatment for patients with scaphoid nonunions includes either inlay bone grafting (Russe) or iliac crest bone grafting with screw fixation, achieving successful union ∼ B90% of patients.
Objective
The aim of the study was to evaluate the results of the treatment of nonunited scaphoid fractures using Herbert screws and cancellous bone grafting. Patients and methods The study included 16 patients with established nonunion of the scaphoid that was treated using Herbert screw fixation and bone grafts. The average age of the patients at the time of surgery was 30.75 years (ranging from 24 to 38 years). The causes of injury were different, ranging from motorcycle accidents to road traffic accidents, and the majority of cases were the result of falling on outstretched hands and onto dorsiflexed and pronated wrists. Results were evaluated using the modified scaphoid outcome scoring system including assessment of pain, motion and strength of the wrist, occupation with regard to wrist injury, and overall satisfaction with the results of the operation after 12 months of follow-up.
Results
Ten patients had well to excellent results (62.5%), four had fair results (25%), and two had poor results (12.5%). The average range of radial deviation was 181, the average ulnar deviation was 231, and the average palmar flexion and dorsiflexion range was 331. The strength of the power grip on the fractured wrist was lower when compared with the nonaffected wrist. In one patient (12.5%), the fracture failed to unite and hence another operation using a bone graft was required. A hypertrophied scar was observed in two patients (12.5%). Despite the small number of patients, we found that the Herbert screw fixation and bone graft technique is an ideal solution for established scaphoid nonunion.
Conclusion
Bone grafting with Herbert screw fixation is a reliable and successful technique for treating patients with scaphoid nonunions.