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SCAPHOID NON-UNION – A CASE SERIES OF 50 PATIENTS

Sunil Garg^*; Sunil Bajaj^*; and R. Wetherall

^* Specialist Registrar, King’s College Hospital, London; Consultant Orthopaedics, William Harvey Hospital, Ashford

50 consecutive cases of Scaphoid non-union were treated by open reduction and internal fixation. Average age of non-union was 2.8 yrs ranging fron 6 months to 6 years. Most common approach used was volar. Herbert screw was used to fix 48 non-unions while K wires were used in 2 cases. Bone graft was harvested from patient’s iliac crest and was used in nearly all cases. Wrist was immobilised in a plaster for an average duration of 12 weeks post operatively. All the cases were done by a single surgeon and the cases were recorded by an independent observer.

The average follow up was 2 years ranging from 1 year to 6 years. Radiographic union was achieved in 45(80%) cases. Failure of union was seen in 10 cases out of which 5 were proximal pole fractures of which 2 went into avascular necrosis. Denervation of wrist, proximal row carpectomy and four corner fusion was used in 5 cases to salvage the wrist.

This modest study carried out at a district general hospital of South East England suggests that scaphoid bone continues to be a challenge for general orthopaedic surgeon as some of these fractures are missed initially. Open reduction and internal fixation of Scaphoid non-union continues to give a predictable outcome.

Correspondence should be addressed to Mr Bimal Singh, c/o BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE