Treatment of scaphoid nonunion by radical curettage, trapezoidal iliac crest bone graft, and internal fixation with a Herbert screw

Ten adult male patients with scaphoid nonunions were treated by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw. The mean patient age was 24.7 years, and the mean duration of the nonunion before surgery was 37.3 months. Mean follow-up time was 30.4 months. Nine of the ten nonunions healed, although one patient required a second bone-grafting procedure. The mean postoperative grip strength was 45.0 kg, and the mean postoperative pinch strength was 11.5 kg. The mean postoperative range of motion was volar flexion, 76.1 degrees; dorsiflexion, 74.2 degrees; radial deviation, 22.1 degrees; and ulnar deviation, 40.1 degrees. The scapholunate angle decreased from a mean of 72.8 degrees preoperatively to 60.6 degrees postoperatively (p less than 0.025). The mean carpal index was 0.57 postoperatively. Mean scaphoid length increased postoperatively and was within 0.2 mm of the opposite (normal) scaphoid in every patient except the single patient with a persistent nonunion (p less than 0.025). All patients returned to work (eight as laborers), and nine of ten wrists were subjectively rated as good or excellent. The results of the series suggests that treatment of displaced scaphoid nonunion by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw is an effective method of treatment that reconstitutes scaphoid anatomy and promotes excellent wrist function.