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Abstract
Purpose:
To evaluate the clinical and radiographic outcomes of scaphoid nonunion patients who had treated by open reduction and internal fixation with Herbert screw through dorsal approach.
Methods:
We reviewed prospectively a series of 102 consecutive patients with scaphoid nonunion (Mack-Lichtman stage I, II, III). All patients were managed with open reduction with dorsal approach and internal fixation with a Herbert screw and additional K-wires. Exclusion criteria included conservative treatment, percutaneous fixation, scaphoid nonunion advanced collapse wrist. There were 94 male and 8 female with an average age of 28 years (range, 13–65 years). The mean follow period was 35 months (range, 12–96 months). Postoperative radiographs were reviewed to assess the fracture union, carpal alignment, and screw position. Functional results were evaluated by modified Mayo wrist score.
Results:
Ninety-eight of 102 patients (96.1%) showed radiographic union at an average time of 12.7 weeks. Modified Mayo wrist score was 87.5 points in an average. Ninety-two of 102 patinets (91.3%) showed more than good results. There was no major complications. There was no statistically significant difference between the preoperative and postoperative radiolunate angle, scapholunate angle, or height to length scaphoid ratio.
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Fig. 1.
(A) Skin incition. (B) The extensor retinaculum between second and third extensor compartment is incised. (C) By placing retractors, the extensor carpi radialis longus tendon is retracted radially and the extensor carpi radialis brevis and the extensor pollicis longus tendons are retracted ulnarly. A longitudinal capsulotomy is performed along the long axis of the incision.
Fig. 2.
(A) When a satisfactory reduction has been achieved, provisional fixation is obtained with two 0.045 K-wires which were inserted eccentrically from the dorsal ridge of the radius to slightly volar to the central axis of the scaphoid axis. (B, C) Using the K-wires as lever-arm, a scaphoid is volar flexed for the screw which is then inserted in the central axis. (D) Two K-wires which were fixed eccentrically is retracted volarly but not removed for additional stability. (E) In case of cyst formation, we can do additional bone graft through dorsal window after fixation of the scaphoid.
Fig. 3.
(A) 0.045 K-wire are inserted perpendicularly to the central axis of the scaphoid into the proximal and distal scaphoid fragments. Reduction of the nonunion site is attempted with assist of the joystick K-wires. (B) After insertion of the iliac bone graft into the gap, provisional fixation with two K-wires which were inserted eccentrically as the same procedure as simple nonunion. (C) Using the K-wires as a lever-arm, the scaphoid is volar flexed. (D) Herbert screw fixation is done in the central position with a free hand technique.
Table 1.
Method of treatment
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