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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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(5):16 Int Orthop. 2020 Nov;44(11):2385-2393.What this means for my practice?
The results of this study may suggest that K-wire fixation and Herbert screw fixation provide similar clinical outcomes with regards to healing time, post-operative pain, function, strength, range of motion, and radiological measures for the treatment of unstable scaphoid waist fracture non-union. There was a lack of outcomes assessing the ease surgical procedure and cost-effectiveness which future studies should investigate as K-wires are typically cheaper to procure and may be easier to use than Herbert screws. The single-center nature of the study is also a limitation, and larger multi-centered trials comparing the two fixation methods are of interest.
Study Summary
One hundred and twenty-two patients with unstable scaphoid waist fracture non-union without avascular necrosis were randomized to receive fracture fixation with Kirshner wires (K-wires) (n=61) or a Herbert screw (n=61). The outcomes of interest included pain on a Visual Analog Scale (VAS), range of motion and grip strength as a percentage of the healthy side, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, scapholunate angle, radiolunate angle, carpal height index, lateral intrascaphoid angle, time to union, time to K-wire removal, time to return to work, and the incidence of adverse events. The mean follow-up period was 34-35 months post-operation. Results revealed no statistical significant differences in all outcomes between the two groups (p>0.05 for all).
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