الفهرس 
Introduction
Wrist biomechanicsOnly 14 pages are availabe for public view
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Abstract
Fractures of the scaphoid comprise 70% to 80% of injuries to carpal bone. Studies suggest that only 5% to 10% of these fractures proceed to nonunion. This risk of delayed healing or nonunion have been attributed to delay in beginning treatment, inadequate immobilization, displacement of the fragments, instability due to ligamentous injury or inadequate blood supply of the proximal fragment. Nonunion of the scaphoid usually causes pain and weakness which interfere with work and sport, also nonunion would most probably result in carpal osteoarthritis. Sixteen patients with symptomatic nonunion of the scaphoid had been treated by iliac bone graft and Kirschner wire fixation in the period from September 2001 to November 2002 in Mansoura University Hospital. The patients presented with pain, limited range of wrist of motion and weak grip strength. The average age was 27.6 years. The average time of delay before the operation was 32 months (3 months <U+2013> 60 months). The average duration of follow up period was 9 months. Union was achieved in 15 patients (93.75%) at an average period of 20 weeks (16 <U+2013> 28 weeks). According to Weightington wrist scoring system: 13 patients (81.25%) had excellent results, 2 patients (12.5%) had good results, one patient (6.25%) had poor results, and no fair results. Iliac bone graft and Kirschner wire fixation is an effective procedure for management of scaphoid nonunion. It is simple, cheep procedure that does not need special equipments and fixation does not add much to the operative time. In the final follow up of the cases there are marked improvement in pain, wrist motion, wrist function and handgrip strength that allows most of our patients to return to their pre injury activity. Our conclusions from this study include the following: i?Iliac bone graft and Kirschner wire fixation is an effective procedure for management of scaphoid non union as it gives a high rate of union in reasonable time ii?This procedure is simple, cheep, Kirschner wire fixation does not add much to the operative time and does not need special equipments. iii?There are marked improvements in pain, wrist motion, wrist function and handgrip strength with this method of treatment. iv?Time of delay since injury until the operation does not affect union rate. v?No correlation between the duration of postoperative immobilization and the ultimate range of motion of the wrist after grafting and Kirschner wire fixation of scaphoid union. In our study the final postoperative impairment of wrist function is 17% inspite of postoperative immobilization for average of 3 months, while in other studies which use the AO cannulated screws and Herbert screws the postoperative impairment of function is respectively 16%, 15%. vi?This type of fixation does not need a second operation for removal of wires after union nesthesia.