Outcomes of volar locking plate fixation and bone grafting for scaphoid fracture non-unions
Arif Bagawan1, Ritesh Sharma1, Najab Ellahee1
1Epsom and St Heliers Hospital Nhs Trust, United Kingdom.
Background:
Scaphoid fractures are the most common carpal bone fractures and are particularly prone to non-union due to their distinctive blood supply1. If left untreated, scaphoid non-union may result in carpal collapse and severe degenerative arthritis, leading to significant impairment of hand function. Delayed or missed diagnoses increase the risk of non-union and subsequent osteoarthritis. Open reduction and internal fixation (ORIF) with bone grafting have become the standard approach to prevent the progression of arthritis resulting from non-union2. However, the optimal fixation method remains uncertain in cases where screw fixation is not feasible3. This study investigates the outcomes of volar locking plate fixation for scaphoid non-union.
Methods:
We conducted a retrospective review of 20 patients treated at a single centre from May 2017 to December 2024 for unstable scaphoid non-union using ORIF and bone grafting. All patients received the Medartis TriLock 1.5 mm volar locking plate. We assessed union clinically and radiographically. All patients who had previously undergone unsuccessful conservative treatment or failed screw fixation were included. Patients with significant comorbidities affecting healing, such as uncontrolled diabetes or severe vascular disease, were excluded. Functional outcomes were assessed using the QuickDASH score, with a minimum follow-up period of 15 months.
Results:
Among the 20 patients treated with the volar locking plate, 18 (90%) achieved union at a mean of 32 weeks. The average QuickDASH score was 21 (range 0-42), and all patients returned to work. Complications included one broken screw, two cases of screw backout, and one instance of implant impingement. These findings demonstrate a 90% union rate, an average healing time of 32 weeks, and a mean QuickDASH score of 21, indicating the effectiveness of this treatment approach despite minor complications.
Conclusion:
ORIF with a volar locking plate and autologous distal radius bone grafting represents a reliable option for unstable scaphoid non-union, particularly when screw fixation is inadequate. This method demonstrated high union rates, satisfactory functional outcomes, and a low rate of implant-related complications.
