REPEAT SCREW STABILIZATION WITH BONE-GRAFTING AFTER A FAILED HERBERT-SCREW FIXATION FOR ACUTE SCAPHOID FRACTURES AND NONUNIONS

Eight patients with persistent nonunions after failure of a Herbert sc rew fixation for both acute scaphoid fractures and nonunions underwent repeat screw internal fixation and bone grafting. They were followed for at least 1 year (average, 19 months) after their last surgical pro cedure. In 6 patients, union was achieved following the second surgery . These patients were pain free and resumed their previous occupations . The average range of wrist mobility was 87% of that of the uninvolve d wrist, and grip strength averaged 93% of that of the uninvolved wris t, In 1 of the 2 patients with an unsuccessful outcome after the secon d procedure, union was achieved after a third procedure was performed that involved an inlay bone graft and internal fixation using a Kirsch ner wire. The remaining patient had relief of pain following denervati on of the wrist joint. These 2 patients did not show marked clinical i mprovement and required a change of employment of light work. On the b asis of study findings, it appears that revision with a repeat Herbert screw fixation and bone grafting is the treatment of choice for patie nts with persistent scaphoid nonunions following an unsuccessful Herbe rt screw procedure in which the screw is not correctly placed.