Abstract
Introduction
It is well established that non-union of the scaphoid requires operative intervention to achieve stable union, restore scaphoid anatomy and prevent further degenerative change. Acutrak screw has been shown to have better biomechanical compression properties than the Herbert screw in the laboratory setting. The aims of the study were to assess the rate of union, the functional outcome and post- operative complications of patients with the two different screw systems.
Methods
A retrospective review of the patients who had undergone surgery for non-union of scaphoid treated by a single surgeon. The first group consisted of 61 patients who were treated with Herbert screw and iliac crest bone graft between July 1996 and June 2000. The rate and time to union were assessed clinically and radiologicaly. Their post-operative functional outcome was assessed with modified Mayo wrist score. Results were compared to second group of 71 patients treated with Acutrak screw plus iliac crest bone graft between July 2000 and December 2005.
Results
The mean ages of patients (25yrs in Herbert Vs 27yrs in Acutrak) were similar in both groups. The mean time interval between injury and surgery was 12.2months for Herbert group and 17months in Acutrak group.
Herbert group had 77% (47) union rate compared to 93% (66) for the Acutrak group. There was persistent nonunion in 14 (22.9%) and 5 (7%) patients in Herbert and Acutrak groups respectively. Functional outcome were excellent in 41% of cases, good in 26% of cases, fair in 22%, and poor in 11 % of cases in Herbert group. For Acutrak group, the outcome score were better with excellent 60% of cases, good in 25%, fair in 10% and poor in 5% of the cases. Wrist fusion was performed in 4 and 1 cases for Herbert and Acutrak group respectively due to progressive wrist pain.
Conclusion
Acutrak screw offer better union rate and functional outcome following surgery for scaphoid nonunion.
