Practicability and Reliability of a New Locking Plate for Scaphoid Reconstruction in Difficult Pathologies

Hypothesis: Headless compressions screws are usually the most implanted devices for scaphoid nonunions or difficult fractures. For special circumstances when screw osteosynthesis is not possible because of instability of the fragments or failed healing, a special locking plate has been developed. The purpose of this study was to evaluate the practicability and reliability of this new device for difficult scaphoid pathologies.

Methods: Between March 2010 and December 2013, 18 patients (aged between 18 and 56 years) were treated by scaphoid locking plate osteosynthesis. Two patients were operated at least once on the scaphoid. The indication for using the plate was scaphoid nonunion or delayed union in 16 cases and a multifragmentary fracture of the scaphoid in two cases.

The fracture was located in the proximal third of the scaphoid in five cases, in the proximal-middle third in four cases, in the middle third in six cases, in the middle-distal in one case, and in the distal third in two cases. In 15 cases the locking plate fixation was used as primary option.

Results: Seventeen of 18 scaphoids demonstrated bony union 4 months postoperative on average (as shown by computed tomography [CT] scan). Nine of the 18 plates have been removed. Reasons for hardware removal were mechanical disorders of wrist flexion due to impaction of the plate or protrusion of the screws. One patient will be reoperated in terms of delayed union.

Summary: This new locking device for scaphoid reconstruction is a useful tool and reliable backup option in the treatment of difficult nonunions or multifragmentary scaphoid fractures. However, hardware removal should be performed due to intraarticular impaction in most patients. The practicability is excellent, and satisfying fusion rates can be accomplished. We use this plate now as a rescue option in situations when a very stable osteosynthesis is necessary for healing and screw fixation has already failed or may not be practicable.