Fixation techniques for non-union of the scaphoid.

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.

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.