Anterior wedge-shaped bone graft for old scaphoid fractures or non-unions. An analysis of relevant carpal alignment

For appraisal of anterior wedge-shaped grafts for the humpback deformity of the scaphoid, a retrospective study of 27 cases with old scaphoid fractures or non-unions was carried out. 11 cases were treated with Herbert screw fixation and anterior wedge-shaped graft and the other cases with other methods. For the assessment of carpal alignment, radio-lunate and scapho-lunate angles were measured with peri-operative radiographs. For the clinical assessment, the scoring system of Cooney was applied. In 25 cases, primary bone union was obtained with one attempt and in two cases, with the second operation. Union was achieved in a mean of 3.4 months. The post-operative wrist score ranged from 65 to 100 with an average 81.2 points. There was a statistically significant relationship between the wrist score and the post-operative scapho-lunate angulation of the affected wrist. The humpback deformity of scaphoid non-union should be treated precisely with carpal realignment surgery or anterior wedge-shaped bone graft.