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Abstract
Purpose
To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse.
Methods
A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography.
Results
All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary.
Conclusion
Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.
Figures and Tables
Fig. 2
Plain radiographs and illustrations of two headless screws inserted in the scaphoid after anterior wedge bone graft. (A) On palmar view, the first screw (a) was inserted near center of the each pole (dashed line). Then, the second screw (b) was inserted more palmarly abutting the subchondral bone. (B) Lateral view of the scaphoid with 2 headless screw fixation.
Fig. 3
Comparing preoperative and postoperative changes in scapholunate angle (A), radiolunate angle (B) and height-to-length ratio (H/L ratio) of the scaphoid (C) (*p<0.05).
Fig. 4
Representative case of a scaphoid waist nonunion in a 15-year-old patient with humpback deformity. (A) Preoperative radiographs and computed tomography (CT) scan in the long axis of the scaphoid. (B) Postoperative radiographs and CT scan in the long axis of the scaphoid at 2 months follow-up demonstrating union of scaphoid and correction of the deformity.
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