Revisional Surgery for Scaphoid Nonunion

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Journal of the Korean Society for Surgery of the Hand 2008;13(1):8-14.
Published online March 1, 2008.

Ho-Jung Kang, Sung-Hoon Jung, Sang-Hoon Park, Su-Keon Lee, Soo-Bong Hahn

주상골 불유합에 대한 재수술의 치료결과

강호정, 정성훈, 박상훈, 이수건, 한수봉

Abstract

Purpose
To evaluate the outcome of revisional surgery on scaphoid nonunions after operation. Materials and Methods: Five patients who underwent revision for scaphoid nonunion from May, 2000 to December, 2005, after primary surgery failure were studied. The average age was 32.8 years. Follow up period was an average 19.4 months (5~43 months). The diagnosis of scaphoid nonunion was made after an average of 52 months postoperatively. Fresh fractures were treated using internal fixation in 3 cases; K-wires were fixed in 2 cases and Herbert screw was inserted in 1 case. The other two cases were treated using internal fixation and bone graft as the primary operation. Fracture fragment excision and salvage operation were excluded. Proximal pole of scaphoid included 3 cases and waist fracture 2 cases. Fixation using Herbert screw was applied on 4 patients, and one case was done using multiple Kirshner's wire. Results: After second surgery through fixation using Herbert screw and bone graft, union was achieved after an average 4 months on all cases except for 1 case that required reoperation. All cases were satisfactory clinically after revisional surgery and there was no poor result. However, in three cases, mild pain persisted after union, and on final observation after the second surgery, the motion range of wrist joint showed improvement: flexion 68 on average (30~90,) extension 36 (15~80,) radial deviation 12 (10~15,) and ulnar deviation 15. Conclusion: Revisional surgery with Herbert screw and cancellous chip bone graft proved to be a useful treatment method when considering secondary surgery after scaphoid nonunion.

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