gms | German Medical Science

Purpose: The purpose of this study was to assess union and complication rates associated with the use of volar locking plate and wedge bone grafting for the treatment of unstable scaphoid fracture waist nonunions.

Methods: A total of 8 patients (7 male and 1 female; mean age, 32.38 years) with unstable scaphoid waist nonunions were treated by reduction of the collapse deformity, insertion of volar wedge bone graft, and internal fixation with the use of volar locking plate and screws with a mean follow up of 9.25 months. The mean duration of nonunion was 19 months. Three of the 8 patients were smokers. Thumb spica splint was recommend for 2 weeks after operation and The wrist is then supported with a removable thumb spica brace until there are radiographic signs of scaphoid healing. Union was determined by radiographs and computed tomography, and range of motion, scapholunate and radiolunate angles were calculated on final radiographs and follow-up computed tomography.

Results: All 8 scaphoids united in a mean time for 8.5 weeks (6 - 12 weeks). Both scapholunate angle and radiolunate angles decreased, returning to normal range.

The average extension-flexion arc of the injured wrists was 128 degrees(59° flexion, 69° extension), which was improving 34% of pre-operative range of motion and 16 % less than that of the uninjured wrists. Pro- and supination were normal. All patients had satisfactory correction of scaphoid deformity and the associated dorsal intercalated segment instability. No hardware problems were identified and no revision procedures have been necessary during follow-up period.

Conclusion: The use of volar locking plate with wedge bone graft for the treatment of unstable scaphoid nonunion is safe and effective. It may provide rapid union and permit earlier rehabilitation of the wrist.