Pediatric scaphoid nonunion.
OBJECTIVE
To report the outcome of pediatric scaphoid nonunions treated with a Herbert screw and bone graft.


METHODS
This is a retrospective review of 12 cases of scaphoid nonunion in 12 skeletally immature patients treated with a uniform approach consisting of open reduction, iliac crest bone grafting and Herbert screw fixation. All patients were boys and presented with nonunions of the scaphoid waist. The final follow-up evaluation was at a mean of 32 months, ranging from 22 to 45 months, and consisted of assessing anatomic snuffbox tenderness, wrist arc of motion, grip strength, calculation of the Modified Mayo Wrist score, and assessment of union based on plain radiographs.


RESULTS
At the latest follow-up evaluation, all patients were pain free (including absence of snuffbox tenderness) except one who experienced slight discomfort during extreme activities. There was no statistically significant difference in the arc of motion between the surgically treated and healthy sides, and the average grip strength was 96% that of the contralateral extremity. Clinical and radiographic union was present in all cases at a mean of 3.4 months after surgery. The Modified Mayo Wrist score was excellent in 11 patients and good in 1. There were no complications.


CONCLUSIONS
Open reduction and internal fixation with a Herbert screw reliably obtained union in all patients.


METHODS
Therapeutic IV.
Chloros
George D
GD
First Department of Orthopaedic Surgery, University of Athens School of Medicine, KAT Accident Hospital, Athens, Greece. gchlorosdoc@uk2.net
Themistocleous
George S
GS
Wiesler
Ethan R
ER
Benetos
Ioannis S
IS
Efstathopoulos
Dimitrios G
DG
Soucacos
Panayotis N
PN
D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007085:Ilium / Q000637:transplantation; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000502:physiology