Scaphoid plating for recalcitrant scaphoid fractures: a systematic review

Abstract

We conducted a systematic review of scaphoid plating for recalcitrant scaphoid fractures using EMBASE, Pubmed, Cochrane and MEDLINE. Thirteen studies were included. Ninety-three per cent of cases reported were male with a mean age of 27 years. Bony union was reported in eleven studies and achieved in 72% to 100% of cases. Scaphoid plates showed no significant difference in union incidence compared with headless compression screws. Mean removal incidence of plates was 21%. Postoperative flexion–extension arc was 119°. Grip strength improved by 14% postoperatively over that before surgery. There was a general improvement in patient-reported outcome measures. Eighty-six per cent of reported participants returned to their previous work. In these clinical reports, plates frequently required removal more frequently than headless compression screws.

The corticocancellous press fit iliac crest bone dowel for recalcitrant scaphoid nonunion: analysis of union rate and clinical outcome

“…Scaphoid union by dowel was achieved in 73% (11 patients) of cases. Time to partial union was 7.2 weeks (range 6-12) with time to complete union averaging at 12.9 weeks (range [11][12][13][14][15]. Bony consolidation at proximal pole occurred in 56% of all proximal pole revisions and in 100% of nonunions of the middle third; this was, however, not significant (p = 0.1).…”

“…In cases of previous headless compression screw placement and nonunion, the scaphoid is left with concavities along the screw channel rendering the chances of repeated screw purchase difficult if not impossible. The introduction of scaphoid plate fixation by Ender in 1977 has since evolved, yielding high consolidation rates in mixed primary and secondary reconstruction series [14][15][16]. Due to intraarticular placement and necessary plate removal in 21% of cases, we evaluated further options.…”

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

“…18 Plate fixation, although providing greater stiffness, stability, and energy absorption to a single screw in biomechanical testing on cadaveric nonunion models (and similar results to dual screw fixation), confers a high risk of secondary hardware removal and cannot be inserted arthroscopically. 10,19 These limitations led to the design of the neutralization screw-a cannulated screw with an even-pitched thread design which aims to avoid compression and maintain achieved reduction while avoiding secondary operations for hardware removal and enabling early mobilization. Inhouse finite element analysis revealed a significantly greater load to failure when utilizing a neutralization screw over a construct comprised of three K-wires (the only other modality that will theoretically result in stabilization without compression), although a comparison with cannulated compression screws has not been performed.…”

“…Plate fixation, although permitting rigid stabilization with maintenance of deformity correction, cannot be utilized arthroscopically and requires removal at a higher rate than intramedullary screw fixation. 10 The ideal fixation modality would permit arthroscopic insertion and provide rigid fixation in the setting of large osseous defects while maintaining correction of deformity and allowing the commencement of early motion. We describe the use of a novel screw design in our technique of arthroscopic management of scaphoid nonunions and present early to midterm results in our series of patients.…”

Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases

“…The authors believe that important factors in ensuring the healing rate of a scaphoid nonunion were sufficient structural integrity and rotational control of the fixation. Compared with double-screw fixation, locking plate fixation appears to be associated with a greater risk of complications, mainly plate impingement to the distal radius, resulting in plates requiring removal more frequently than headless compression screws (32). Thus, some surgeons proposed that the plate fixation method serves as an additional option in the treatment of recalcitrant scaphoid nonunions or patients with failed prior surgical intervention (33).…”