Comparative study between usage of Herbert screw versus Kirschner wires in the management of nonunited fracture scaphoid

Abstract

Purpose This study aimed to compare between the usage of Herbert screw versus Kirschner wires (K-wires) in the treatment of nonunited fractured scaphoid regarding the most effective and less complicating procedure. Patients and methods It is a retrospective, comparative study that compared the usage of Herbert screw versus K-wires with bone graft from iliac crest in the management of patients with nonunited scaphoid fractures who were admitted in the Department of Orthopedic Surgery in Alzahraa University Hospital during the period from October 2016 to June 2018. Twenty patients were included in the study. Among them, 10 were subjected to internal fixation using Herbert screws, while 10 patients were subjected to internal fixation using K-wires. Results Patients subjected to K-wires achieved a union rate (80%) superior to patients subordinated to Herbert screw (60%) as a method of internal fixation. Moreover, patients subjected to Herbert screw suffered more complications in the form of impingement with pain and progressive degeneration. Patients subjected to K-wires had a better functional outcome when compared with those exposed to the Herbert screw. In multivariate regression analysis, only male patients appeared to be independent predictors of time to bone healing. Conclusion A combination of thorough impaction of iliac bone graft, and internal fixation with K-wires, and Herbert screws provides a good option for the treatment of scaphoid nonunion with superiority of K-wires regarding safety, feasibly, and outcomes when compared with Herbert screw especially in the absence of avascular necrosis of the proximal fragment.