Comparison of Bone Graft and Fixation Techniques in Scaphoid Nonunion

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Journal of the Korean Society for Surgery of the Hand 2003;8(2):60-66.
Published online June 1, 2003.

Seung-Koo Rhee, Seok-Whan Song, Joo-Yup Lee, Sung-Chul Yang, Ho-Wook Song

주상골 불유합에서 골이식술 및 고정 방법에 따른 치료 결과

이승구, 송석환, 이주엽, 양성철, 송호욱

Abstract

Purpose
To compare the results of inlay bone graft versus anterior interpositional wedge bone graft, and Kwire fixation versus Herbert screw fixation for the treatment of scaphoid nonunion. Materials and Methods: Twenty four patients with scaphoid nonunion who underwent open reduction, bone graft and internal fixation between 1994 and 2000 were investigated. Postoperative results were assessed using elapsed time to union, degree of correction of the humpback deformity and carpal instability, arthritic changes of the carpal joints. Clinical results were compared with modified Mayo wrist scoring system. Results: The rate of union was not different between inlay bone graft and anterior interpositional wedge bone graft, but the difference was significant between K-wire fixation and Herbert screw fixation (75% vs. 92%). Satisfactory correction of humpback deformity and dorsal intercalated segmental instability (DISI) could be obtained with anterior interpositional wedge bone graft. Four patients with persistent nonunion were treated with limited intercarpal fusion, but had a significantly worse in clinical outcome. Conclusions: To achieve bone union, Herbert screw fixation is superior to K-wire fixation. To correct the humpback deformity and DISI, anterior interpositional wedge bone graft is recommended.

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