Arch Hand Microsurg 2019; 24(4): 311-320  
Treatment of Unstable Scaphoid Nonunion Using a Volar Locking Plate
Young Woo Kwon1, Ji Hun Park2, In Cheul Choi1, Jae Jun Nam1, Jong Woong Park1
1Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea
2Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
Correspondence to: Jong Woong Park
Department of Orthopaedic Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea
TEL: +82-2-920-5924, FAX: +82-2-924-2471, E-mail: ospark@korea.ac.kr
Received: August 26, 2019; Revised: October 9, 2019; Accepted: October 16, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 nonunion 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.
Keywords: Scaphoid, Nonunion, Wedge bone graft, Locking plate


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