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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 8, pp 1161–1169 | Cite as

Practicability of a locking plate for difficult pathologies of the scaphoid

  • Isabella M. MehlingEmail author
  • A. Arsalan-Werner
  • V. Wingenbach
  • J. Seegmüller
  • M. Schlageter
  • M. Sauerbier
Handsurgery
  • 31 Downloads

Abstract

Introduction

Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies.

Materials and methods

Between March 2010 and December 2014, 20 patients (age range 16–59 years) were treated with scaphoid locking plate osteosynthesis. In 17 cases it was due to scaphoid nonunion or delayed union and in three cases to treat a complex multi-fragmentary fracture of the scaphoid. Most of the initial fractures were located either in the proximal third (n = 9) or the middle third (n = 8) of the scaphoid.

Results

Mean follow-up was 14.6 ± 8.9 months (range 2–30 months). All three scaphoid fractures (100%) showed bony healing in the CT scan after 2.7 ± 0.6 months. 15 of 17 (88.2%) patients with scaphoid nonunion demonstrated bony healing in the latest CT scan at an average of 6.2 ± 8.1 months (range 2–11 months) after scaphoid reconstruction. Range of motion (extension/flexion) was 104° ± 18.4° (range 80°–150°) and about one third less than the unaffected side. The average grip strength averaged 38.2 kg on the operated side and 44.1 kg on the unaffected side after surgery.

13 plates (65%) had to be removed due to impaction of the plate or protrusion of the screws.

Conclusions

This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.

Keywords

Scaphoid Nonunion Comminuted scaphoid fracture Locking plate Fixation 

Notes

Acknowledgements

We thank our librarian Claudia Diemann-Paeth for helping with the literature research.

Compliance with ethical standards

Conflict of interest

Michael Sauerbier has a consulting contract with Medartis AG, Switzerland. The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division for Hand SurgerySt. Vincent Hospital HanauHanauGermany
  2. 2.Department for Plastic, Hand and Reconstructive SurgeryBG Trauma CenterFrankfurt am MainGermany
  3. 3.Academic Hospital of the Goethe University Frankfurt Am MainFrankfurt am MainGermany

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