KIRSCHNER WIRES VERSUS HERBERT SCREW FIXATION WITH BONE GRAFT IN CASE OF NONUNITED SCAPHOID WAIST FRACTURE

Abstract

Background: Scaphoid nonunion is challenging to manage because of the geometry of the scaphoid, the direction and type of fracture, and the vascular pattern of the blood supply to the scaphoid. Fracture proximal to the perforating vessels on the dorso-radial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Objective: To compare the impact of the Kirschner wires versus Herbert screw fixation with iliac bone graft on the rate of union, time to union, correction of deformity, and clinical outcome in adults with nonunited scaphoid waist fracture without avascular necrosis. Patients and Methods: We prospectively randomized 40 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. This study was conducted in the Department of Orthopedic surgery at Al-Hussien University Hospital, Faculty of Medicine, Al-Azhar University during the period from February 2018 to April 2020. Radiographs, clinical outcome measures (pain, range of motion, and grip strength) were done pre- and post-operatively. Results: No significant difference detected between the two groups with respect to the time to union, rate of union, deformity correction, pain analysis, range of motion, grip strength, and complications. Conclusion: Combination of impaction of iliac bone graft, and internal fixation with k-wire or Herbert’s screw provided a good option for treatment of scaphoid nonunion. However, because of kirschner wires has a shorter operative time, lower cost and easy application as compared with the Herbert screw, so k wire may be a good alternative to Herbert screw.