Outcomes of Scaphoid Nonunions following Fixation with Headless Compression Screws: A Retrospective Cohort

Abstract The treatment of scaphoid nonunions remains a challenge, with multiple surgical techniques described. The purpose of this retrospective study was to evaluate the union rates in patients undergoing treatment of scaphoid nonunion with a single headless compression screw and the risk factors associated with failure to achieve union. Using the CPT code for the repair of a scaphoid nonunion (25440), 167 patients were identified as having operative repair of a scaphoid fracture nonunion using headless compression screw fixation performed at a single institution between the years of 2002 and 2024. All patients were followed clinically and with serial radiographic analysis postoperatively to determine if union was achieved. The primary outcome of fracture union was analyzed for each patient. Demographics of individual patients, fracture characteristics, and different autograft types were collected as a secondary analysis to evaluate for risk factors for scaphoid nonunion repair failure. The overall union rate was 75.5% (126/167). Female patients trended toward a higher rate of union following repair compared with male patients, although statistical significance was not fully met (p = 0.07). Age, time from injury to surgery, fracture location, bone graft source, bone graft type, avascular necrosis, tobacco use, and workers' compensation did not demonstrate a significant impact on union rates. No difference was found in the union rate of scaphoid nonunion repairs based on the graft harvest location or graft type. Fixation with headless compression screws and autologous bone graft is a reliable, effective method for treating scaphoid nonunions, with union rates similar to those previously reported. Female patients trended toward having a higher rate of union following repair, although statistical significance was not reached. Therapeutic Level IV.