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Outcomes Following the Use of Two Scaphoid Compression Screws for the Treatment of Acute Fractures and Nonunions
Ryan M. Garcia, MD; Fraser Leversedge, MD; J. Mack Aldridge, MD; Marc Richard, MD; David Ruch, MD;
Duke University Medical Center

Introduction: Compression screws have become the mainstay of surgical treatment for scaphoid fractures and nonunions. Biomechanical studies have demonstrated superior rotational stability with the use of 2 compressions screws in scaphoid fractures, however, clinical outcomes have not been evaluated. We reviewed the clinical and radiographic outcomes of this novel method of fracture stabilization.

Materials and Methods: Between 2009 and 2011, 20 patients (19 Male/1 Female, Age 23.3 years) were treated with open reduction and internal fixation with 2 scaphoid screws for either an acute scaphoid fracture (n=8) or a nonunion (n=12) (Figure 1). Patients were treated an average of 1 month after injury for acute fractures and 14 months for nonunions. Fractures occurred at the waist (n=15), proximal pole (n=3), or the distal third (n=2). Dorsal (n=12) and volar (n=8) surgical approaches were used. Nine nonunions underwent iliac crest bone grafting at the time of skeletal fixation followed by postoperative bone stimulation.

Results: All fractures had radiographic and clinical evidence of bone union at an average of 3 months postoperatively. CT scans were obtained in 10 patients without evidence of screw penetration of the scaphoid cortex. No complications occurred and no revision procedures have been necessary.

Conclusion: Our results indicate the use of 2 compression screws for the treatment of acute scaphoid fractures or nonunions is a safe and effective treatment modality. This technique may provide superior biomechanical stability and improve outcomes of scaphoid fracture repair.


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