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Arch Hand Microsurg > Volume 24(4); 2019 > Article
Archives of Hand and Microsurgery 2019;24(4):311-320.
Published online December 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.4.311   
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. ospark@korea.ac.kr
2Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
Received: 26 August 2019   • Revised: 9 October 2019   • Accepted: 16 October 2019
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.
Key Words: Scaphoid, Nonunion, Wedge bone graft, Locking plate
 


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