Union Rate of Scaphoid Non-Union Fracture in Adults by Herbert Screw Versus Volar Buttress Plate

Evaluation of Union Rate of Scaphoid Non-Union Fracture in Adults by Herbert Screw Versus Volar Buttress Plate

This study aimed to evaluate the short-term results of treating non-united scaphoid waist fractures with a humpback deformity by graft and internal fixation using a volar buttress plate versus the use of a Herbert screw.

Scaphoid fracture is the most common fracture, accounting for roughly 60% of the total carpal bone fractures and 11 % of all hand fractures.

Nonunion occurs in approximately 5% to 25 % of scaphoid fractures. The scaphoid nonunion will collapse into a humpback deformity, and the lunate, together with the proximal pole, into a dorsal intercalated segment instability, which might end in an advanced carpal collapse.

A scaphoid screw acts to prevent bending at the fracture site with three-point fixation within the cancellous bone of the scaphoid. The proximal and distal points of purchase are achieved by the capture of the screw threads in the cancellous bone of the proximal and distal poles of the scaphoid. The third point occurs within the cancellous bone of the scaphoid waist.

Inclusion Criteria:

• Age of a patient is between 20 years to 50 years.
• Non-union or delayed union scaphoid wrist fracture (more than 3 months).
• Closed fracture.
• Patients without previous scaphoid surgery.
• Patients without abnormal renal and/or liver functions.
• Patients without hypocalcemia and/or vitamin D3 deficiency.

Exclusion Criteria:

• Open fracture.
• Patients with proximal or distal fracture of the scaphoid.
• Patients with avascular necrosis of scaphoid.
• Patients with mid-carpal arthritis or pan-carpal arthritis.
• Patients with carpal instability.