Background: The most controversial problem in treating scaphoid fractures is whether bone grafts are necessary for cystic-type fractures.
Methods: We treated 105 scaphoid fractures using Herbert screws (1988-1997), AO 3.0 mm cannulated screws (1998-2002), and Acutrak screws (2003-2006). The patients ranged in age from 14 years to 67 years (average, 26 years). Our classifications were based on the radiographic findings: linear type (51 cases); cystic type (24 cases); and sclerotic or displaced type (30 cases). Linear and cystic types did not have any displacement more than 2 mm. If the fracture line had a sclerotic zone thicker than 1 mm, it was classified as sclerotic or displaced. The length of time before surgery did not affect the classification. Osteosynthesis was performed--without bone graft in all linear cases, with a bone graft in 7 and without a bone graft in 17 cases in cystic type, and with all bone graft in sclerotic or displaced type.
Results: Bone union was achieved in all cases in linear type. There were one failure (AO) in 7 cases with bone graft and 3 failures (1 Herbert and 2 AO) in 17 cases without bone graft in cystic type. All 10 cases achieved bone union without bone graft in cystic type using Acutrak screw. There were two failure cases (2 AO) in sclerotic or displaced type.
Conclusions: Screw fixation without bone graft using Acutrak screws was a reliable strategy for the treatment of cystic-type scaphoid fractures.