ESTABLISHED NONUNION OF THE SCAPHOID TREATED BY VOLAR WEDGE GRAFTING AND HERBERT SCREW FIXATION

We reviewed 26 consecutive men of mean age 28 gears who had had wedge bone grafting and Herbert screw fixation for symptomatic established n onunion of the waist of the scaphoid. The period between injury and op eration averaged 30 months (10 to 96), and 11 of the 26 patients had h ad previous operations, seven with bone grafts, At a mean follow-up of 14 months (6 to 42) 25 fractures (95%) had united at a median time of four months, Symptoms were improved in an patients. The outcome was n ot related to the time between injury and surgery or to pre-existing d egenerative changes. Previous surgery carried a worse prognosis. The t echnique is difficult but can achieve union even when previous surgery and bone grafting have failed, The usual result is improved function and some relief of pain.