Percutaneous Screw Fixation of Scaphoid Nonunion Without Bone Grafting

BACKGROUND: This study evaluated the results of minimally invasive headless compression screw (HCS) fixation for treatment of scaphoid delayed union or nonunion. A minimally invasive approach has several potential benefits, including preservation of an already tenuous scaphoid blood supply. It was hypothesized that minimally invasive HCS fixation results in healing of scaphoid fracture with delayed union via increased fracture compression and biomechanical stability, while preserving soft tissue envelope and blood supply. METHODS: This retrospective review considered patients diagnosed with a scaphoid nonunion or delayed union who underwent minimally invasive HCS fixation at a single tertiary care medical center. The primary outcome was postoperative union as assessed on plain radiographs by an independent fellowship-trained musculoskeletal radiologist. Secondary outcomes included measurement of preoperative radiolunate and scapholunate angles, return to work/sport status, and presence of documented complicationsResults:This study included 21 patients. The mean time from injury to surgery for all patients was 106 days (range 40-399 days). Fifteen patients achieved scaphoid healing, 2 patients had <50% fracture healing, and 4 patients had persistent nonunion on final available radiographs. CONCLUSIONS: Minimally invasive HCS skeletal fixation of scaphoid delayed unions and nonunions demonstrated a 71.4% postoperative radiographic union rate. While preoperative radiolunate and scapholunate angles and age at time of surgery did not predict postoperative union rates, increased time of >4 months from injury to surgery was associated with persistent nonunion. Within this suggested timeframe, percutaneous HCS fixation provides reasonable healing rates for delayed scaphoid unions, regardless of fracture location within the scaphoid.