Introduction : The use of headless screws ( HS ) is recommended during internal fixation in cases of scaphoid nonunion, but it is difficult to treat scaphoid nonunion with HS fixation after the failure of internal fixation. Therefore, we used a locking plate system to achieve internal fixation in a case of scaphoid nonunion after a failed operation. We report two cases of postoperative nonunion after attempted fixation with HS. The patients underwent a vascularized bone graft transfer from the distal radius and internal fixation with a locking plate system.
Case : The patients were 19 and 47 years old, respectively, and were both male. The previous operative procedures included percutaneous screw fixation, and a free bone graft combined with screw fixation. The time between the first and second procedures was 12 and 22 months, respectively. In each case, preoperative X-rays showed that bone union had not been achieved, and bone defects were present around the proximal or distal screw. We harvested the flap from the dorsal part of the distal radius using the Zaidemberg method after removing the screw, placed a vascularized grafted bone on the radial side of the scaphoid bone, and inserted a locking plate on the volar side.
Results : Bone union was successfully achieved in both cases, and the clinical results were good ( the mean Mayo wrist score was 82.5 points ).
Conclusion : Our combined surgical procedure involving vascularized bone grafting and locking plate fixation is useful for treating scaphoid nonunion after HS fixation.