Reduction of the scaphoid fracture with DISI alignment.

Eight cases of symptomatic malunion and nonunion of scaphoid fractures with dorsiflexed intercalated segment instability (DISI) alignment were treated by open reduction, anterior wedge-shaped bone grafting, and internal fixation using Herbert's screw. In four malunited fractures, osteotomy at the fracture line was done before the reduction. The DISI alignment was reduced by insertion of the Kirschner wire into the lunate and flexing it anteriorly. After the bone grafting to the anterior bony defect of the scaphoid, which was created by the Kirschner wire reduction, internal fixation was accomplished by the use of Herbert's screw. In all cases fusion was obtained within 4 months. Radiographic assessment indicated that the DISI alignment and the angulated scaphoid were corrected to achieve a nearly normal pattern. Pain, restricted motion of the wrist, and the grip strength were improved.