Comparative outcomes of acute versus delayed or nonunion scaphoid fractures treated with headless compression screw fixation: a 10-year single-center retrospective study

Purpose: This study aimed to compare outcomes of headless compression screw (HCS) fixation among acute, delayed union, and nonunion scaphoid fractures treated at a single center between January 2014 and December 2024.Methods: In this retrospective cohort study, patients diagnosed with scaphoid fractures based on radiologic findings who underwent HCS fixation were included. Exclusion criteria comprised scaphoid nonunion advanced collapse, complex carpal fractures, advanced avascular necrosis, open fractures, bilateral fractures, and prior surgery on the ipsilateral wrist. The primary outcomes were time to union and the postoperative nonunion rate. Patients were categorized according to the injury-to-surgery interval: acute (<6 weeks), delayed (6 weeks to <6 months), and nonunion (>6 months or confirmation by computed tomography regardless of chronicity).Results: Of the 177 patients included, 128 were classified as acute, 19 as delayed, and 30 as nonunion. The mean injury-to-surgery interval was 1.7±1.3, 8.5±2.2, and 22.1±25.3 weeks for acute, delayed, and nonunion cases, respectively. Mean follow-up duration was 12.6±16.2 months in the acute group, 9.6±11.9 months in the delayed group, and 16.0±18.2 months in the nonunion group. Time to union averaged 3.6 months for acute cases, 3.7 months for delayed cases, and 4.7 months for nonunion cases. Postoperative nonunion occurred in 18 acute cases (14.1%), 2 delayed cases (10.5%), and 4 nonunion cases (13.3%). Differences in time to union and postoperative nonunion rates were not statistically significant among the groups.Conclusion: HCS fixation achieved comparable union rates and healing times across all groups, indicating that it is an effective treatment option for scaphoid fractures regardless of chronicity.