Occurrence of carpal osteoarthritis after treatment of scaphoid nonunion with bone graft and herbert screw: a long-term follow-up study.

PURPOSE To determine the occurrence, progression, and clinical results of osteoarthritis (OA) after bone grafting and Herbert screw fixation for scaphoid nonunion. METHODS Fifty patients were reviewed (mean follow-up period, 12.0 +/- 1.6 y) to analyze degenerative changes of the wrist after use of Herbert screws for scaphoid nonunion. RESULTS Radiologic signs of OA were observed in 15 of 50 patients before surgery and in 23 of 50 after 10 years or more. The majority of degenerative changes were low grade. No OA at follow-up evaluation was seen in 27 of 35 patients with no preoperative degenerative changes. In 6 of 8 patients with OA its occurrence was either subsequent to concomitant injury, occurred after incorrect scaphoid reconstruction, or was caused by persistent nonunion. Of 15 wrists with OA at the time of surgery 9 remained unchanged and 6 increased in severity. Healing of nonunion was achieved in 42 of 50. Range of motion, however, was reduced to 88% of that of the opposite hand. At follow-up evaluation the mean Disabilities of the Arm, Shoulder, and Hand score was 9 +/- 13 and the mean Cooney score was 80 +/- 10. CONCLUSIONS The results show high patient satisfaction and good function after healing of scaphoid nonunion. In the long term correct anatomic reconstruction of the nonarthritic carpus with a Herbert screw prevents onset of OA in most patients.