Surgical Treatment of Scaphoid Nonunion

Thim, Jae Ik; Kim, Taek Sun; Lee, Sung Jong; Lee, Suk Ha; Yoo, Chang Moo; Han, Kil Joo

Abstract

The scaphoid fracture is the most common fracture of the carpal bone in young men and has high incidence of nonunion. Many methods of treatment for nonunion of the carpal scaphoid have been described; bone grafting, screw fixation, pulsed electromagnetic field and cast, percutaneous pinning and Herbert screw fixation. Two of the commonest methods of treatment are Matti-Russe procedure and Herbert screw fixation and this paper compares these two surgical treatments. At the Department of Orthopaedic Surgery, Korea Veterans Hospital, from October 1988 to October 1994, 11 cases of the scaphoid nonunion had been treated by Matti-Russe procedure only (4 cases), Matti-Russe procedure with K-wire (2 cases) and Bone graft with Herbert screw fixation (5 cases) and followed up more than 1 year. The results were as follows; 1. Among 11 cases, 10 cases were male and 1 case was female and the range of age was 19-46 years (Mean 26.2 years). 2. The sites of fracture were confined to the waist in 9 cases (82%) and prox 1/3 in 2 cases (18%). 3. The treatment methods were Matti-Russe only in 4 cases, Matti-Russe procedure with K-wire in 2 cases and Bone graft with Herbert screw fixation in 5 cases. 4. Postoperative cast immobilization was done for 16.5 weeks in the cases treated by Matti-Russe procedure and for 4 weeks in the cases treated by Bone graft with Herbert screw fixation. 5. The union rate was 91 % after postoperative 4 months (Mean 4.1 months). 6. The results of treatment were excellent in 7 cases (64%), good in 3 cases (27%) and fair in 1 case(9%). Therefore the Matti-Russe procedure and Bone graft with Herbert Screw fixation are good procedures in the treatment of scaphoid nonunion. But, Bone graft with Herbert screw fixation is more useful in young men because of short periods of immobilization and early returning to work.