Scaphoid Nonunion Management with Headless Screw versus Volar Locking Plate Fixation: A Meta-Analysis
Duncan S Van Nest, BA1; Clay Townsend, BS2; Asif M Ilyas, MD, MBA1
1Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA; 2Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Volar plate fixation, however, has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or multifragmented nonunions. The purpose of this meta-analysis was to compare union rates and clinical outcomes between volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods:
We performed a literature search of studies documenting outcomes for scaphoid nonunion treatment with either screw fixation, plate fixation, or both using PubMed, SCOPUS, Cochrane Library, and Google Scholar from 2000 to 2020. Inclusion criteria consisted of (1) adult patients with average age > 18 years, (2) primary study using either screw fixation, plate fixation or both, with discrete data reported for each procedure, (3) average follow up of at least 3 months. Exclusion criteria consisted of (1) studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using generalized linear models. Results:
A literature search resulted in 925 articles from 2000 to 2020 before inclusion and exclusion criteria were applied. Ultimately, 23 articles were included for analysis. These articles consisted of 14 distinct cohorts treated with screw fixation and 12 cohorts treated with plate fixation. In total, 395 patients treated with screw fixation and 209 with plate fixation were included for final analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery (p=0.001) and were more likely to have had prior surgical intervention (p=0.011). There was no significant difference between union rates at 92% and 94% for screw and plate fixation, respectively (p=0.642). However, plate fixation resulted in longer time to union (p=0.02) and lower modified Mayo wrist scores (p=0.001). Conclusions:
- Patients treated with plate fixation were more likely to present with recalcitrant nonunions.
- There was no statistically significant difference in union rates between screw and plate fixation.
- The results from this meta-analysis support the use of plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical intervention.
Back to 2021 Abstracts