Outcomes of volar locking plates for scaphoid fractures- A single surgeon case series

Surgical management of scaphoid fractures has traditionally been with headless compression screws.

Our primary aim was to establish the non-union rate in our series of patients whose scaphoid fractures were managed with volar locking plating. Our secondary aims were to assess; post-operative range of motion, post-operative grip strength, functional outcome and the removal of metal rate.

We underwent a retrospective review of 35 continuous patients who underwent surgery between June 2018 and August 2023 under a single surgeon for a scaphoid fracture using a Medartis volar locking plate for their primary surgery. Non-union was assessed radiographically on plain radiograph, or on a CT scan if union wasn't clear on the plain radiograph. Range of motion was measured bilaterally using a goniometer, and grip strength with a dynamometer. Functional outcome was assessed with a PRWHE score.

We had a non-union rate of 2.75%. There was a significant decrease in range of motion compared to the contra-lateral side. There was a significant decrease in grip strength compared to the contralateral side. Average reported PRWHE was 10.9. There was a 34% removal of metal rate.

Our series demonstrated excellent union rates. Range of motion and grip strength were decreased in the operative side compared to the contralateral side. PRWHE scores were relatively low and comparable to the scores in the published literature. The volar locking plate demonstrates increased stability compared to one headless screw, particularly rotational stability. However, there is a higher risk of needing a second operation for removal of symptomatic metalwork compared to when using headless compression screws.