Background Management of delayed scaphoid fractures in physically demanding patients remain controversial ,this article discus simple treatment accelerate healing and allow early mobilization.
The purpose of the study was to evaluate results of percutaneous headless compression screw fixation with bone marrow injection in scaphoid delayed-union fractures and allow early mobilization of wrist to achieve early return to ADL.
Methods: Twenty patients (22 scaphoid) with scaphoid delayed-union fractures underwent percutaneous headless screw fixation with bone marrow injection from iliac bone. The inclusion criteria in this series were scaphoid fracture delayed-union with intact cartilaginous envelope, no sclerosis, no avascular necrosis.
Results: Mean follow up period 20.4 months (range from: 12 to 24) , average radiographic union was 7.8weeks (range 6–10 weeks) , average VAS score was 0.05 (range 0–1). Average wrist range of motion was flexion of 85° (range 75–90), extension 76.5° (range 70–85) , radial tilt 18.5° (range 15–20), ulnar tilt 42.5° (range 39–45) . Average grip strength was 95 % (85–100%).
Conclusion: Percutaneous technique fixation for scaphoid fractures is a reliable and less harmful method and help in early return to activity, dorsal approach allow proper screw positioning and allow use of hook to correct minimal displacement and gain best compression in fracture site .Refresh fracture ends by k-wire and bone marrow injection help to accelerate union with less invasive method. Best results of percutaneous technique in delayed union scaphoid fractures with intact cartilaginous envelope, no sclerosis, no avascular necrosis.