Evaluation of treatment of nonunited middle third scaphoid fractures using threaded Kirschner wires fixation with iliac bone grafting

Objectives
To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures.
Background
Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment.
Patients and methods
This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year.
Results
One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks.
Conclusions
Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.