Treatment of unstable scaphoid waist nonunion with cancellous bone grafts and cannulated screw or Kirschner wire fixation

Abstract

We compared two methods of fixation for unstable scaphoid waist nonunions regarding rate of scaphoid union, union time, deformity correction, clinical outcomes (pain, range of motion, and grip strength), and QuickDASH scores. Eighty-nine patients who undergo cancellous iliac bone grafting and internal fixation either with a Herbert screw (n = 46) or multiple Kirschner wires (n = 43) were evaluated. The rate of scaphoid union in the K-wire group was 98% (n = 42) versus 89% (n = 41) in the screw group. The mean union time and duration of surgery for K-wire group versus screw group were 12 versus 15 weeks and 45 versus 66 min respectively. There was no significant difference between the two groups with respect to deformity correction, clinical outcomes, and QuickDASH scores. Despite there was no significant difference in the rate of scaphoid union between the two fixation methods, the K-wires procedure had the advantages of short union time, less demanding, and less expensive than the screw implant.

Keywords:

• Scaphoid
• nonunion
• scaphoid nonunion
• DISI
• Herbert screw
• Kirschner wire
• scaphoid waist fracture

Disclosure statement

The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.