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Subject Area

Orthopedic Surgery

Article Type

Original Study

Abstract

Objectives To compare the results of threaded Kirschner wire (K-wires) and Herbert screw in the treatment of nonunion scaphoid using iliac graft. Background Scaphoid nonunion is challenging to manage because of its geometry, the direction and type of fracture, and the vascular supply to it. Patients and methods This prospective study included 30 patients with nonunion scaphoid fracture in the Orthopedic Department of Menoufia University and El-Qabary Hospital from 2019 to 2021. Patients were divided into two equal groups according to the fixation method (group A by threaded K-wires, and group B by Herbert screw) with open reduction and iliac bone graft using the volar approach. The mean age was 26.60 ± 5.58 years in group A and 27.33 ± 5.09 years in group B. These patients were assessed clinically using modified Mayo wrist score, Quick disabilities of arm, shoulder and hand-9, and radiologically. Result Union was achieved in 86.7% in group A and 100% in group B. The mean union time was 10.92 ± 1.55 weeks in group A and 12.13 ± 1.77 weeks in group B. The mean 6-month score postoperatively was 81.67 ± 9.39 in group A and 82.67 ± 6.23 in group B according to the modified Mayo score and 25.67 ± 14.97 in group A and 23.93 ± 11.25 in group B according to Quick disabilities of arm, shoulder and hand-9. Radiologically, 26.7% were grade 1, 60% were grade 2, and 13.3% were grade 4 after 6 months postoperatively in group A and 40% were grade 1 and 60% were grade 2 in group B. Conclusions Combination of iliac bone graft and threaded K-wires or Herbert screw provides a good option for the treatment of scaphoid nonunion without superiority regarding outcomes.

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