Scaphoid Nonunion: Herbert Screw Fixation through Dorsal Approach

Lee,  Sang Hyun; Oh,  Jong Seok; Seo,  Chang Hyo; Kim,  Yong Jin

doi:2013.18.2.49

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Original Article

Journal of the Korean Society for Surgery of the Hand 2013;18(2):49-58.
Published online June 30, 2013.
DOI: https://doi.org/10.12790/jkssh.2013.18.2.49

Scaphoid Nonunion: Herbert Screw Fixation through Dorsal Approach

Sang Hyun Lee, Jong Seok Oh, Chang Hyo Seo, Yong Jin Kim

¹Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea.
²Centum Institute for Hand and Microsurgery, West Busan Centum Hospital, Busan, Korea. yjkimhs@ymail.com

Received: 24 April 2013 • Revised: 9 June 2013 • Accepted: 10 June 2013

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.

Conclusion
Herbert screw fixation through dorsal approach was a reliable method for patients of scaphoid nonuinion to achieve bony union with high functional scores and without major complications.

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