Arch Hand Microsurg.  2019 Dec;24(4):311-320. 10.12790/ahm.2019.24.4.311.

Treatment of Unstable Scaphoid Nonunion Using a Volar Locking Plate

• Kwon YW
• Park JH
• Choi IC
• Nam JJ
• Park JW

• KMID: 2464466
• DOI: http://doi.org/10.12790/ahm.2019.24.4.311

Abstract

PURPOSE
The purpose of this study is to assess the results of treatment of unstable scaphoid nonunion using a wedge iliac crest bone graft and a volar locking plate and screw system.
METHODS
Seventeen patients are included in the study and the average age was 30.4 years. The mean duration of non-union was 44.8 months. All patients underwent open reduction, wedge-bone grafting from the iliac crest, and internal fixation using a 1.5 mm volar locking plate and screw. The nonunion sites were scaphoid waist in 12 patients and proximal pole in 5 patients. The mean follow up periods after the operation was 10.2 months. The mean union time was determined with plain radiographs and computed tomography scan. At final follow-up, range of motion (ROM) of the wrist, scapholunate and radiolunate angles, and height-to-length ratio were measured.
RESULTS
All 17 scaphoids united in a mean time of 7.9 weeks after operation. Both scapholunate angle and radiolunate angles are recovered within the normal range. The average extension-flexion arc of the injured wrists was 127.9 degrees, which was improved over 34% of preoperative ROM. Pro- and supination were normal. There was no hardware related problems and no plate removal was necessary during the follow-up period.
CONCLUSION
The use of an anatomical 1.5 mm volar locking plate with an anterior wedge iliac bone graft provides optimal stability for the unstable scaphoid nonunion. The rapid union after the plate fixation allowed earlier rehabilitation without cast immobilization which is usually performed with other fixation methods.

Keyword

Scaphoid; Nonunion; Wedge bone graft; Locking plate

MeSH Terms

Follow-Up Studies
Humans
Immobilization
Range of Motion, Articular
Reference Values
Rehabilitation
Supination
Transplants
Wrist

Figure

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  Fig. 1 Burring sclerotic fracture margin and cystic portion and check punctuate bleeding.

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  Fig. 2 Reduction and temporary K-wire fixation then wedge structural bone graft is inserted.

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  Fig. 3 Plate positioning and locking screw are inserted.

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  Fig. 4 Ensure proper screw length with various radiographic views.

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  Fig. 5 Representative case of a scaphoid waist nonunion in a 20-year-old patient with humpback deformity. (A) Preoperative radiographs and computed tomography (CT) scan in the long axis of the scaphoid. (B) Postoperative radiographs and CT scan in the long axis of the scaphoid at 8 weeks follow-up demonstrating union of scaphoid and correction of the deformity.

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  Fig. 6 (A, B) Plain radiographs and (C) illustrations of pre-contoured 1.5 mm volar plate fixed in the scaphoid after anterior wedge bone graft.

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  Fig. 7 Proximal scaphoid watershed line (PSWL) is the point at which the nonarticulating portion of scaphoid bone becomes articulating.

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