Evaluation of union rate of scaphoid non-union fracture in adults by Herbert screw versus volar buttress plate

Purpose

The disability and pain after a neglected scaphoid non-union fracture are well recorded in the literature. We aimed to compare and detect the short-term results of non-united scaphoid waist fracture treated by internal fixation and bone graft with the volar buttress plate utilization versus the Herbert screw.

Methods

This is a therapeutic study. This randomized, prospective comparative an intervention study was carried out on 30 cases with non-union scaphoid waist fractures. They were randomly categorized into two equal groups, group (A) treated by volar buttress plate fixation with bone graft, and group (B) managed by Herbert screw fixation along with bone graft. Bone graft in both groups was taken from the distal radius. All cases underwent clinical examination and radiological evaluation.

Results

With an average of 18 months, thirty cases were followed up. Both groups had similar baseline characteristics. The union rate and time were insignificant difference between both groups. Insignificant differences were determined across either intervention groups in terms of grip strength, the visual analogue pain scale (VAS), the Mayo wrist score, and the quick disabilities of arm, shoulder and hand score (quick DASH score) during the early interval of follow-up postoperatively (at 3, 6, 9 and 12 months). Group (A) demonstrated shorter operative time and lower numbers of image intensifier intraoperatively in contrast to group (B). Hardware removal after union was needed in 3 patients of group (A) in variance to group (B), in which no cases need implant removal. The Radio-scaphoid (RS) impingement and flexor carpi radialis (FCR) tenosynovitis exhibited a significant elevation in group (A) in contrast to group (B). Among the patients with scaphoid fracture non-union who underwent surgery, some cases did not achieve union after the initial procedure. We had to employ an alternative fixation method for these cases, and we followed them until union was achieved, and their function was restored. Specifically, three patients from group (A) (20%) [one case was fixed with a miniplate 2 mm, and two cases were fixed with a microplate 1.5 mm] and two patients from group (B) (13.3 %) required this approach.

Conclusions

The functional and radiological outcomes are comparable between volar buttress plate and Herbert screw in the treatment of non-united waist scaphoid fracture. The rate of removal of the implant is higher in the volar buttress plate.