Scaphoid nonunion treated with bone graft and Herbert screw. 23 of 28 fractures healed

We retrospectively reviewed 28 patients with symptomatic, established nonunion of the waist of the scaphoid who were treated with bone grafting and Herbert screw fixation. A volar approach was used in 20 patients, and a dorsal in 8. Grafting was performed with cancellous bone from the radius in 16 patients and a iliac wedge graft in 12 patients. At a mean follow-up of 3 (1-6) years. 5 of the 28 patients had not united. The surgical approach, the type of graft applied, and the duration of postoperative immobilization played a role for the final outcome. The volar approach appeared to be associated with a better outcome which may be attributed, in part, to the relatively better view of the nonunion achieved with this incision compared to the dorsal approach. The iliac wedge graft was more effective for reduction of the deformity and initial stabilization. We believe that the relatively long period, 3 months, of postoperative immobilization negatively effected the postoperative function because of stiffness.