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J Wrist Surg
DOI: 10.1055/s-0044-1793941
Special Review Article

Palmar Plate Fixation in Scaphoid Nonunions—Surgical Technique and Review of the Literature

Stefan Quadlbauer
1   AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Vienna, Austria
2   AUVA Research Center, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria
3   Austrian Cluster for Tissue Regeneration, Vienna, Austria
,
Chistoph Pezzei
4   Hand Center Rudolfinerhaus, Vienna, Austria
,
Wolfgang Hintringer
5   Döbling Private Hospital, Vienna, Austria
,
Thomas Beer
1   AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Vienna, Austria
,
Thomas Hausner
1   AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Vienna, Austria
2   AUVA Research Center, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria
3   Austrian Cluster for Tissue Regeneration, Vienna, Austria
6   Department of Orthopedics and Trauma surgery, Paracelsus Medical University, Salzburg, Austria
,
Martin Leixnering
4   Hand Center Rudolfinerhaus, Vienna, Austria
,
Josef Jurkowitsch
1   AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Vienna, Austria
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Abstract

Even today, the treatment of scaphoid nonunions remains challenging for the treating hand surgeon. Considering the biomechanical principles of wrist kinematics, especially the three-dimensional movement of the scaphoid, it is evident that a single headless compression screw does not provide sufficient stability to counteract all these forces, particularly rotational forces. Palmar plate fixation was initially introduced as a salvage procedure after failed screw fixation. It ensures very high rotational stability but also supports correction of the humpback deformity, reconstruction of scaphoid length, and prevents bone graft extrusion. However, indications have since been extended to include primary nonunion treatment in cases with humpback deformity or comminuted fractures. Even in recalcitrant cases (substantial bone loss, prior surgery failure, avascular necrosis, or durations exceeding 2 years), high union rates and favorable functional outcomes have been reported. This article attempts to summarize the biomechanical principles, indications, surgical techniques, and results following palmar angular stable plate fixation in scaphoid nonunions.

Keywords

scaphoid nonunion - plate - complications - outcome


Publication History

Received: 16 December 2023

Accepted: 18 October 2024

Article published online:
20 November 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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