Treatment of Scaphoid Nonunion Using 2 Small Diameter (2.2 mm) Headless Compression Screws

Park,  Ji Hun; Kwak,  Dong Hee; Park,  Jong Woong

doi:2017.22.3.180

Arch Hand Microsurg > Volume 22(3); 2017 > Article

Original Article

Journal of the Korean Society for Surgery of the Hand 2017;22(3):180-188.
Published online September 30, 2017.
DOI: https://doi.org/10.12790/jkssh.2017.22.3.180

Treatment of Scaphoid Nonunion Using 2 Small Diameter (2.2 mm) Headless Compression Screws

Ji Hun Park, Dong Hee Kwak, Jong Woong Park

Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul, Korea. ospark@korea.ac.kr

Received: 25 May 2017 • Revised: 12 July 2017 • Accepted: 21 July 2017

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.