Retrograde Herbert Screw Fixation in Treatment of Nonunion of Proximal Scaphoid Fractures

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Journal of the Korean Society for Surgery of the Hand 2002;7(1):8-14.
Published online January 1, 2002.

Ho-Jung Kang, Sang-Ho Lee, Kye-Wook Song, Soo-Bong Hahn, Eung-Shick Kang

주상골 근위 골절 불유합의 역방향 Herbert 나사 내고정술

강호정, 이상호, 송계욱, 한수봉, 강응식

Abstract

We reviewed eight cases of patients who underwent retrograde Herbert screw fixation with autogenous bone graft for treatment of proximal pole scaphoid nonunions. Most nonunion of the carpal scaphoid can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Eight patients with proximal pole scaphoid fractures with nonunion were treated with retrograde Herbert screw fixation using the dorsal approach and autogenous bone grafting. All patients were immobilized after operation with cast immobilization for an average of seven weeks. Eight patients were all males, with ages ranging between 23 to 26 years. Among the eight cases, four patients were neglected for an average of 13 months, three patients were treated with cast immobilization for 8 weeks, and one patient had a previous surgical treatment. Union was achieved in all cases and average time to union was 15.3 weeks. Among 8 cases 4 had excellent results and 4 had fair results, according to Maudsley and Chen protocols. Retrograde Herbert screw fixation should be considered in the treatment of small proximal pole fracture of scaphoid with nonunion.

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