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Fixation techniques for non-union of the scaphoid.

P K Raju¹, Sunil Gurpur Kini

¹Department of Orthopaedics, Bangalore Medical College and Research Institute, Karnataka, India.

Journal of Orthopaedic Surgery (Hong Kong)

|April 27, 2011

Summary

The Kohlman modification of vascularised muscle pedicle graft offers the quickest scaphoid union time, especially for old non-unions or proximal pole fractures. This surgical technique provides comparable functional outcomes to other fixation methods.

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Area of Science:

Orthopedic surgery
Traumatology
Hand surgery

Background:

Scaphoid non-union presents a significant challenge in orthopedic practice.
Various fixation modalities exist, each with potential benefits and drawbacks.

Purpose of the Study:

To compare the outcomes of three distinct fixation methods for scaphoid non-union.
Evaluate Herbert screw fixation, Matti Russe bone grafting, and the Kohlman modification of vascularised muscle pedicle graft.

Main Methods:

A randomized trial involving 33 patients (27 men, 6 women) with scaphoid non-union.
Participants were allocated to Herbert screw fixation (n=11), Matti Russe bone grafting (n=9), or Kohlman modification (n=13).
Involved proximal, waist, and distal pole scaphoid fractures with a mean non-union duration of 10 months.

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Main Results:

All 33 patients achieved successful scaphoid union at a mean of 15-17 weeks, with the Kohlman group showing the earliest union.
Significant improvements were observed in scapholunate and radiolunate angles, range of motion (112 to 155 degrees), and grip strength (30% increase).
Functional outcomes were comparable across groups, with no hardware failures or iatrogenic fractures reported.

Conclusions:

The Kohlman modification of vascularised muscle pedicle graft demonstrated the fastest time to union.
This technique is particularly recommended for patients with chronic scaphoid non-union (over 1 year) or proximal pole fractures.