The unstable nonunited scaphoid waist fracture: results of treatment by open reduction, anterior wedge grafting, and internal fixation by volar buttress plate.

PURPOSE: The purpose of this study is to evaluate the results of treatment of unstable nonunited scaphoid waist fracture by anterior wedge graft and internal fixation with the use of volar buttress plate and screws.

METHODS

Fourteen adult male patients with unstable nonunited scaphoid waist fracture with a humpback deformity were treated by reduction of the collapse deformity, insertion of anterior wedge graft, and internal fixation with the use of volar buttress plate and screws. The mean patient age was 26 years, and the mean duration of the nonunion before surgery was 16.5 months. The follow-up time ranged from 9 to 19 months (mean, 11 mo). Thirteen of the fourteen nonunions healed with sound radiographic union. Pre-existing avascular necrosis was a major adverse factor for achievement of union in one patient, even after a second bone-grafting procedure.

RESULTS

Union was achieved in a mean of 3.8 months. Most of the patients had satisfactory correction of scaphoid deformity and the associated dorsal intercalated segment instability. Postoperatively, improvements were seen in the range of wrist flexion and extension, grip strength, and degree of dorsal intercalated segment instability.

CONCLUSIONS

The results of the series suggest that the method of anterior wedge graft and internal fixation with the use of volar buttress plate and screws is effective for the treatment of unstable nonunited scaphoid waist fractures.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.