Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using cortic
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ORIGINAL PAPER
Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial Galal Hegazy 1 & Ehab Alshal 2 & Mohamed Abdelaal 1 & Mohamed Abdelaziz 1 & Mohamed Moawad 1 & Yasser M. Saqr 3 & Ibrahem El-Sebaey 1 & Mokhtar Abdelazeem 1 & Mohamed El-Barody 4 Received: 9 February 2020 / Accepted: 13 July 2020 # SICOT aisbl 2020
Abstract Purpose The study compared the impact of the Kirschner wires versus Herbert screw fixation on the rate of union, time to union, correction of deformity, and clinical outcome in adults with unstable scaphoid waist fracture nonunions without avascular necrosis. Methods We prospectively randomized 122 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. Radiographs, clinical outcome measures (pain, range of motion, and grip strength), and the Quick DASH score were taken pre- and post-operatively. Results The rate of the scaphoid union in the Kirschner wire group was 91% versus 88% in the Herbert group. No difference was detected between the two groups with respect to the time to union, deformity correction, pain analysis, range of motion, grip strength, return to work, and complications. Conclusion Using of multiple Kirschner wires as a fixation method for unstable scaphoid waist fracture nonunion that was treated by open reduction and corticocancellous iliac bone grafting had a shorter operative time and lower cost as compared with the Herbert screw fixation. Herbert screw fixation was technically more demanding in terms of technique than K-wires. However, because of easy application of Kirschner wires, and low cost, especially in developing countries, it may be a good alternative to Herbert screw. Keywords Scaphoid . Nonunion . Scaphoid nonunion . DISI . Herbert screw . Kirschner wire . Scaphoid waist fracture
Level of evidence: I * Galal Hegazy [email protected]
Mokhtar Abdelazeem [email protected]
Ehab Alshal [email protected] Mohamed Abdelaal [email protected] Mohamed Abdelaziz [email protected]
Mohamed El-Barody [email protected] 1
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo 11884, Egypt
2
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut 71524, Egypt
3
Orthopedic Department, Faculty of Medicine, Port Said University, Port Said 11884, Egypt
4
Radiodiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut 71524, Egypt
Mohamed Moawad [email protected] Yasser M. Saqr [email protected] Ibrahem El-Sebaey [email protected]
International Orthopaedics (SICOT)
Introduction The scaphoid is the most commonly fractured carpal bone and account for 60% of all carpal fractures [1, 2]. Approximately about 10% of undisplaced scaphoid fractures fail to unite despite appropriate immobilization [3]. The natural history of the untreated scaphoid waist fracture nonunion
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