Abstract
It has been reported that the frequency of avascular necrosis of the proximal portion of the scaphoid following fracture is very high, and if fracture arises in this portion it is very difficult to obtain bony union. To investigate this, we reviewed the clinical and roentgenographic findings of 13 osteosynthesized scaphoid fractures located in the proximal one third. Subjects camprised 11 men, and two women. There were three acute fractures, one delayed union and nine established nonunions.
Before 1986 we treated this fracture with conventional techniques using bone grafting. Since that time we have synthesized nine fractures using a Herbert screw with five having an additional bone graft. The average follow-up period was 6.0 years ranging from ten months to twelve years.
Clinical results were assessed and graded according to Cooney's Clinical Scoring Chart and roentgenographic findings were assessed. Regarding clinical results, nine were judged as excellent, and three good, one fair, one poor. The rate of union was 100% in all cases of acute and delayed fractures and 88.9% in those with established non-unions.
Before operation, sclerotic changes were found in three cases. But all of them achieved bone union and the sclerotic changes then disappeared.
We believe that osteosynthesis should be achieved to obtain bone union and a good clinical result in cases of fracture of the proximal third of the scaphoid.
