G. Inoue et al., HERBERT SCREW FIXATION FOR SCAPHOID NONUNIONS - AN ANALYSIS OF FACTORS INFLUENCING OUTCOME, Clinical orthopaedics and related research, (343), 1997, pp. 99-106
A retrospective review of 160 cases of scaphoid nonunion treated by in
ternal fixation using a Herbert screw with bone grafting was conducted
at an average followup of 24 months, Definite radiographic union was
achieved in 90% of cases, Based on Cooney's clinical scoring system, 8
0 cases had an excellent result, 37 had a good result, 33 had a fair r
esult, and 10 had a poor result, Failure of union was related to the e
xistence of avascular changes of the proximal fragment, instability of
the fracture fragment, the prolonged delay in surgery, and the locati
on of the fracture site, In-the united scaphoids, the lengthy period o
f postoperative immobilization, the existence of osteoarthritis, and t
he prolonged delay in surgery were significant factors in the patient'
s functional outcome, Overall, the results do not support the view tha
t a residual flexion deformity of the scaphoid is less likely to yield
a satisfactory outcome, although it seems worthwhile to correct exces
sive angulation at the time of repair to promote an anatomic union, th
ereby preventing early arthritis, A bone graft with internal fixation
using a Herbert screw and a shorter period of immobilization may give
a satisfactory functional result when the nonunion is treated before t
he onset of arthritic changes in the wrist.