Fixation techniques for non-union of the scaphoid

To compare outcomes of 3 fixation modalities for scaphoid non-union.

27 men and 6 women aged 20 to 48 (mean, 28) years with non-union of the scaphoid involving the proximal pole (n=13), waist (n=12), and distal pole (n=8) were randomised to undergo the Herbert screw fixation (n=11), the Matti Russe bone grafting (n=9), or the Kohlman modification of vascularised muscle pedicle graft procedure (n=13). The mean duration of non-union was 10 (range, 6-30) months.

The mean follow-up duration was 28 months. 30 of 33 achieved correction of both scapholunate and radiolunate angles. The mean range of motion increased from 112 to 155 degrees. The mean grip strength increased by 30%. Functional outcomes of the 3 groups were comparable; they were excellent in 13 patients, good in 10, fair in 6, and poor in 4. There was no hardware failure or any iatrogenic fracture during pedicle dissection. One patient had a superficial infection, which was resolved after antibiotic treatment. At the 6-month follow-up, in the respective 3 groups, 8, 6 and 11 patients achieved scaphoid union after mean intervals of 17, 16, and 15 weeks.

The time to union was earliest in the Kohlman modification of vascularised muscle pedicle graft procedure, which is recommended for patients with old non-union (>1 year) or proximal pole fractures.