title: Clinical outcome after alternative treatment of scaphoid fractures and nonunions.
abstract: OBJECTIVE
  Achieving stable fixation of scaphoid fractures and nonunions continues to be a challenge. Compression screw fixation has been the current standard surgical procedure. However, in some cases, bone healing cannot be achieved and requires further revision. Recent series reintroduced volar plating as valid option for stable fixation. The aim of the study was to review clinical outcome of alternative scaphoid treatment.
  
  
  METHODS
  From 2011 to 2014, nine patients with scaphoid fracture were treated by Headless Compression Screw (HCS) and seven patients with scaphoid nonunion by HCS or volar mini condylar plate with bone graft. The average age was 34.4 years and the average time to follow-up was 19.3 months. From 1996 to 1998, 38 patients with scaphoid nonunion were treated using compression screw (S-group) or volar mini condylar plate (P-group) with bone graft. The average age was 39.6 years and the average time to follow-up was 26.2 months.
  
  
  RESULTS
  The union rate was 100%. For scaphoid fractures, the mean Modified Mayo Wrist Score (MMWS) was 94.1 and the DASH score 7.4. From 2011 to 2014, the MMWS was 87.9 and the DASH score 7 in scaphoid nonunions. In the period between 1996 and 1998, the MMWS was 67.2 in the P-group and 58.6 in the S-group, and the DASH score 16.8 and 28.2.
  
  
  CONCLUSIONS
  Our study demonstrated that appropriate application of the HCS was able to produce very satisfactory results in scaphoid fractures and nonunions. In our opinion, however, the method of scaphoid plate osteosynthesis can achieve a higher degree of stability, particularly rotational stability, in case of multifragmentary avascular scaphoid nonunions.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. AnnaLena.Sander@kgu.de.|Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. AnnaLena.Sander@kgu.de.
authors.forename: A L
authors.initials: AL
authors.lastname: Sander
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Sommer
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Schäf
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, St.-Antonius-Hospital, Kleve, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Braun
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Marzi
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Homburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Pohlemann
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Frank
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
keywords: 1,2-ICSRA; Compression screw; Mini condylar plate; Scaphoid fracture; Scaphoid nonunion