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Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial

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Abstract

Purpose

The study compared the impact of the Kirschner wires versus Herbert screw fixation on the rate of union, time to union, correction of deformity, and clinical outcome in adults with unstable scaphoid waist fracture nonunions without avascular necrosis.

Methods

We prospectively randomized 122 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. Radiographs, clinical outcome measures (pain, range of motion, and grip strength), and the Quick DASH score were taken pre- and post-operatively.

Results

The rate of the scaphoid union in the Kirschner wire group was 91% versus 88% in the Herbert group. No difference was detected between the two groups with respect to the time to union, deformity correction, pain analysis, range of motion, grip strength, return to work, and complications.

Conclusion

Using of multiple Kirschner wires as a fixation method for unstable scaphoid waist fracture nonunion that was treated by open reduction and corticocancellous iliac bone grafting had a shorter operative time and lower cost as compared with the Herbert screw fixation. Herbert screw fixation was technically more demanding in terms of technique than K-wires. However, because of easy application of Kirschner wires, and low cost, especially in developing countries, it may be a good alternative to Herbert screw.

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Acknowledgments

We wish to acknowledge the help and guidance provided by our Professors, Ahmed Shamma, Ibrahim Mustaffa, Mohamed Bessar, Ali Algushy, and Ismail Yassin, the members of the ethics committee of the Orthopedic department–Faculty of Medicine–Al-Azhar University–Cairo Egypt.

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Authors and Affiliations

  1. Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt

    Galal Hegazy, Mohamed Abdelaal, Mohamed Abdelaziz, Mohamed Moawad, Ibrahem El-Sebaey & Mokhtar Abdelazeem

  2. Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut, 71524, Egypt

    Ehab Alshal

  3. Orthopedic Department, Faculty of Medicine, Port Said University, Port Said, 11884, Egypt

    Yasser M. Saqr

  4. Radiodiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, 71524, Egypt

    Mohamed El-Barody

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  1. Galal Hegazy
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Correspondence to Galal Hegazy.

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The authors declare that they have no conflict of interest.

Ethical considerations

Our institutional review board approved this retrospective study before commencement.

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All patients were given an information sheet; the risks and benefits of operative treatment were discussed and full written consent was obtained.

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Hegazy, G., Alshal, E., Abdelaal, M. et al. Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial. International Orthopaedics (SICOT) 44, 2385–2393 (2020). https://doi.org/10.1007/s00264-020-04730-7

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