الفهرس 
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Abstract
The carpal scaphoid bone is known to play a key role in the function of the wrist. Therefore, pathologic abnormalities of the scaphoid may have serious consequences. Scaphoid fractures account for 2-7% of all fractures, 69% of all carpal injuries that are commonly seen in the young and healthy population, they are second in frequency only to distal radius fractures, and typically a consequence of fall on the outstretched hand.
Scaphoid delayed union is a difficult surgical problem facing the orthopedic surgeons, and continues to be problem sequalae. Scaphoid fractures fail to heal because of micro-motion and shearing forces at the fracture site results in fibrous tissue formation and a failure of bone healing , also there are biological and clinical factors contribute to the development of delayed union then nonunion including the degree of fracture displacement, the fragile vascular supply of the scaphoid, and its complex architecture also variable patient symptoms such as minimal pain and swelling, compliance with immobilization, lack of medical and radiological diagnosis, and delays in treatment .
Percutaneous cannulated screw fixation of acute scaphoid waist fractures has been used commonly by many authors, reportedly with uniformly high union rates approaching 100%, excellent functional results, rare complications, quicker time to union, and early return to manual work. In recent years, percutaneous compression screws have been increasingly used for treatment of old scaphoid fractures. In recent times, percutaneous bone¬ marrow injection has emerged as a successful alternative to traditional methods of treatment. It is a minimum invasive procedure with negligible complications. It is performed in an outpatient setting under local anaesthesia mostly. So it decreases cost and hospital stay, the present study has been taken up to evaluate the efficacy of this procedure over a period of one year in our department.
The surgical options for the delayed union of the scaphoid are many and each has its own advantages and drawbacks.
In this study, twenty patients of symptomatic delayed union of scaphoid fractures of average time of delay 4 months in adults were surgically treated, all of them were treated by bone marrow injection and percutaneous Herbert screw fixation. A dorsal approach was done in twelve patients while volar approach was done in eight patients. The age of the patients ranged between 18 and 32 years with the mean age 25 years, they were all males (100%).
The mean postoperative range of motion in flexion extension arc was 119°. The mean postoperative grip strength of the affected hand was 215.75 mm hg compared to 220.5 mm hg of the non-affected hand (97.84%).