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ORIGINAL ARTICLE
Year : 2014  |  Volume : 49  |  Issue : 2  |  Page : 112-119

Volar percutaneous screw fixation and autogenous bone marrow injection for acute scaphoid fractures


Department of Orthopaedics, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt

Correspondence Address:
Samir M El-Ghandour
MD, Post Box 1375, Port Said
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1148.145309

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Background Scaphoid fractures are most common in young active men. Undisplaced or minimally displaced scaphoid fractures can be treated either conservatively or operatively by percutaneous screw fixation (PSF) rather than by open surgery. Advantages of PSF are earlier mobilization and return to work with avoidance of complications of prolonged casting and open surgery. The concept of bone marrow injection in cases of delayed healing, nonunion, and poor bone healing is well accepted. Patients and methods Twenty-four patients with undisplaced or minimally displaced scaphoid fractures were treated within 3 weeks of sustaining the injury with PSF using headless cannulated Herbert screws through a volar approach. The fixation procedure was augmented by injection of autogenous bone marrow aspirated from the iliac bone. There were 19 male and five female patients with a mean age of 27.5 years (average 19-47 years). These patients were followed up for a mean period of 10 months (average 7-12 months). Results All fractures united at a mean of 7 weeks (average 6-10 weeks) and all patients returned to sedentary work within 1 week and to manual work within 8 weeks. At last follow-up, average wrist range of motion was extension of 60° (range 50-70) and flexion of 55° (range 50-60) and the percentage of range of wrist motion as compared with the contralateral side was between 85 and 95%, with a mean of 90%. No complications from either procedure were encountered. Conclusion PSF for nondisplaced and minimally displaced scaphoid fractures augmented with bone marrow injection resulted in fast radiographic union and early return to work. The procedure was performed as day-case surgery with no complications. We recommend the use of this procedure for scaphoid fractures with delayed union and certain types of nonunion.


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