Repeat screw stabilization with bone grafting after a failed Herbert screw fixation for acute scaphoid fractures and nonunions.

Abstract

Eight patients with persistent nonunions after failure of a Herbert screw fixation for both acute scaphoid fractures and nonunions underwent repeat screw internal fixation and bone grafting. They were followed for at least 1 year (average, 19 months) after their last surgical procedure. In 6 patients, union was achieved following the second surgery. These patients were pain free and resumed their previous occupations. The average range of wrist mobility was 87% of that of the uninvolved wrist, and grip strength averaged 93% of that of the uninvolved wrist. In 1 of the 2 patients with an unsuccessful outcome after the second procedure, union was achieved after a third procedure was performed that involved an inlay bone graft and internal fixation using a Kirschner wire. The remaining patient had relief of pain following denervation of the wrist joint. These 2 patients did not show marked clinical improvement and required a change of employment of light work. On the basis of study findings, it appears that revision with a repeat Herbert screw fixation and bone grafting is the treatment of choice for patients with persistent scaphoid nonunions following an unsuccessful Herbert screw procedure in which the screw is not correctly placed.