O1102 HERBERT SCREW FIXATION FOR SCAPHOID NON-UNIONS. REVIEW OF FACTORS INFLUENCING OUTCOME

Abstract

Material and Methods: In our study the results of a consecutive series of symptomatic non unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61(91.04%) cases who had symptomatic non unions (type D) were treated with Herbert Screw plus iliac crest bone graft while 6(8.95%) cases were treated for acute unstable fractures (type B)with Herbert screw only (these are excluded from the study). The time interval between injury and surgery was 12.2 months (range 2–72 months) Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. Results:Total No 61, Union 47 (77.1%), Persistent non-union 14 (22.9%). The site of fracture (p=.044), type (p=.028), screw placement (p=.019) were found to be significant factors infl uencing outcome. No statistically significant influence on outcome was found with patient’s age (p=0.983) and also with time interval to non union surgery (p=0.749). Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength and patient satisfaction, functional results were graded as excellent in 19 cases, good in 12 cases, fair in 10 cases and poor in 5 cases. Conclusion: We recommend axial placement of Herbert screw with bone grafting via Russe approach and for difficult proximal pole non unions dorsal approach is recommended.