Screw Fixation Alone for Scaphoid Fracture Nonunion

Ernst, Stephen Michael Crowe; Green, David P.; Saucedo, James M.

doi:10.1016/j.jhsa.2018.03.048

Cited by 17 publications

(18 citation statements)

References 34 publications

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“…For a scaphoid fracture, primary bone healing depends on rigid stabilization of the fracture fragments. The treatment rationale for fixation without grafting is that instability is the main factor disturbing the healing process and that the stability provided by screws results in healing of minimally displaced fractures (Capo et al., 2009; Ernst et al., 2018; Slade et al., 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Patient selection is important. Although Mahmoud and Koptan (2011) claimed that some scaphoid nonunions with gaps of more than 5 mm could be treated with fixation without grafting, most hand surgeons still believe that scaphoid nonunions with substantial bone loss or sclerosis should be treated by open reduction, bone grafting and internal fixation (Ernst et al., 2018). Poor vascularity of the proximal pole may be an important cause of poor success of the fixation without grafting (Capo et al., 2012; Hegazy, 2015; Somerson et al., 2015).…”

Section: Discussionmentioning

confidence: 99%

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Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Guo

Tong

et al. 2020

J Hand Surg Eur Vol

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We retrospectively reviewed 12 minimally displaced fractures of the scaphoid waist in 12 patients who developed delayed or nonunions with or without conservative treatment. Mean time between injury and surgery was 6 months (range 3–12). The fractures were stabilized with double screws, which were percutaneously inserted with robot assistance, and without bone grafting. All fractures united at a mean of 8 weeks (range 6–10) after surgery. The patients were followed-up at 6 months and 1 year. The patients recovered good wrist function. No major postoperative complications were reported, and the patients returned to their usual level of activity. Robot assistance gave a high degree of accuracy when placing the cannulated screws since only two attempts were needed for correct placement of the guide wires. We explain the high union incidence by patient selection, good stabilization and not disturbing the vascular supply. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Guo

Tong

et al. 2020

J Hand Surg Eur Vol

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“…The exact definition and classification of a fracture as a nonunion is controversial. 28,29 Currently, there is no universally accepted time of continued lack of bony healing that defines a nonunion as compared with a delayed union or nascent nonunion. Several authors have defined scaphoid nonunions as fractures that have not demonstrated bony healing at least 6 months postinjury.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have defined scaphoid nonunions as fractures that have not demonstrated bony healing at least 6 months postinjury. 30 Some also define scaphoid fractures that have no evidence of healing at 3 months from injury as nonunions, 28,31 whereas others consider these to be nascent nonunions. 10,31 Conventional treatment of scaphoid nonunions includes screw fixation with nonvascularized bone graft or excision of the proximal pole fragment.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

et al. 2020

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Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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“…improving understanding of scaphoid vascularity, immobilization strategies, and fixation methods, the optimal strategy for the management of scaphoid fractures continues to be elusive. 1,[11][12][13][14][15][16][17] Operative reduction and internal fixation of scaphoid fractures are indicated for displaced or unstable fractures, delayed fracture presentation, proximal pole fractures, open fractures, and established nonunions. 18,19 Multiple fixation strategies have been described for scaphoid fractures including headless compression screws (HCS), plates, staples, and Kirschner wires (K-wires).…”

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confidence: 99%

Excessive Derotational K-Wire Angulation Decreases Compression by Headless Compression Screw

et al. 2021

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Background Scaphoid fracture is the most common carpal bone fracture. Open reduction internal fixation of scaphoid fractures typically undergo stabilization by a single headless compression screw (HCS). During screw insertion, a derotational Kirschner wire (K-wire) is often placed for rotational control of the near and far fragment. Questions/purposes The aim of this study was to determine if there is an angle of derotational K-wire placement in relation to the axis of a HCS that compromises the amount of compression generated at a fracture site by the HCS. We hypothesize that increased off-axis angle will lead to decreased compression across the fracture site. Methods A Cellular Block 20 rigid polyurethane foam (Sawbones, Vashon, WA) scaphoid model was created to eliminate variability in bone mineral density in cadaveric bone. MiniAcutrak HCS screws (Acumed, Hillsboro, OR) were used for testing. Three conditions were tested: (1) HCS with derotational wire inserted parallel to the HCS (zero degrees off-axis); (2) HCS with derotational wire inserted 10 degrees off-axis; and (3) HCS with derotational wire inserted 20 degrees off-axis. Results A statistically significant difference in the mean compression of the control group (56.9 N) was found between the mean compression with the derotational K-wire placed 20 degrees off-axis (15.2 N) (p = 0.001). Conclusions Compression at the fracture site could be impeded by placing an excessively angulated off-axis derotation wire prior to insertion of the HCS. Clinical Relevance Our study adds a new detail to the optimal technique of HCS placement in scaphoid fractures to improve compression and fracture union.

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Screw Fixation Alone for Scaphoid Fracture Nonunion

Cited by 17 publications

References 34 publications

Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Excessive Derotational K-Wire Angulation Decreases Compression by Headless Compression Screw

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