Operative Treatment of the Carpal Scaphoid Nonunions / 대한정형외과학회잡지

ABSTRACT

We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.