AO lag screw combined with distal radius periosteal flap in the treatment of scaphoid fracture nonunion

Abstract

Objective To study the efficacy of AO lag screw combined with distal radius periosteal flap in the treatment of scaphoid fracture nonunion. Methods From September 2009 to December 2015, 17 scaphoid nonunion cases, consisted of 11 waist fracture and 6 proximal fracture nonunion, were treated with AO lag screw combined with distal radius periosteal flap. In these cases, 10 were Herbert C, while 7 were Herbert D. Five cases were combined with proximal ischemic necrosis and 2 cases with styloid arthritis. The distal radius periosteal flap was pedicled with 1,2 ICSRA. Patients had regular X-ray and CT and were evaluated for healing time, wrist pain and range of motion postoperatively. Results These patients were follow-up for 6 to 20 months. The mean follow up time was 13.5 months. The scaphoid nonunion was healed in all the cases. The average time of healing was 12 weeks and wrist pain almost disappeared. According to modified Krimmer wrist scoring system, the results were rated as excellent in 11 cases, good in 5 cases and fair in 1 case. Conclusion AO lag screw combined with distal radius periosteal flap can promote the healing of scaphoid nonunion, especially for Herbert C and D type cases. Key words: Scaphoid bone; Fractures,ununited; Periosteal flap; Fracture fixation