Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert's screw fixation--a study of 49 patients for at least five years

Abstract

The objective of this article is to report our clinical experience in the treatment of patients with scaphoid nonunion using intercalated bone graft and Herbert's screw and the long-term postoperative results with a minimum of five years of follow-up. We retrospectively reviewed 49 patients treated with carved intercalated bone graft and Herbert's screw fixation from September 1987 to June 2001. Preoperative clinical manifestations and postoperative results were assessed by radiography, and functional results, including grip force, range of motion of the wrist joint, and Cooney's scoring chart, were evaluated. The union rate was 93.9%. The average grip power, as well as wrist flexion and extension were significantly improved. Using Cooney's scoring system, 29 patients were rated excellent and 17 good. For successful union, anatomical reduction with carved intercalated bone grafting and Herbert's screw fixation is definitely a reliable option. This method leads to a satisfactory long-term functional outcome.

Figures

Fig. 1

Rüsse classification

Fig. 2

Harvested wedge tricortical bone graft proximal to anterior superior iliac spine; carved according to the defect size; cancellous bone chip gathered; cancellous bone graft impacted to the proximal and distal defects before being inserted into the intercalated bone graft; fixed with Herbert’s screw

Fig. 3

Intraoperative photo after Herbert’s screw fixation

Fig. 4

Case presentation. Left upper pre-op. Right upper post-op one month. Left lower post-op three months. Right lower post-op five years, solid union with remodelling of bone graft. No screw protrusion into the scapho-capitate joint was seen during operation and there was no following evidence of peripheral osteolysis or arthrosis due to screw protrusion