Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft

Abstract

Background Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity.

Purpose The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a “micro” small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm.

Patients and Methods Patients with proximal pole scaphoid fragments comprising less than 20% of the entire scaphoid were included. Fixation was accomplished from a dorsal approach with a micro headless compression screw and distal radius bone graft. Six patients were included. Average follow-up was 44 months (range, 11–92).

Results Mean proximal pole fragment size was 14% (range, 9–18%) of the entire scaphoid. The mean immobilization time was 6 weeks, time-to-union of 6 weeks, and final flexion/extension arc of 88°/87°. All patients had a successful union, and no patient had deterioration in range of motion, avascular necrosis, or fragmentation of the proximal pole.

Conclusion Small diameter screws with a maximal thread diameter of ≤ 2.8 mm can be used to fix the union of proximal pole acute scaphoid fractures comprising less than 20% of the total area with good success.

Level of Evidence Therapeutic case series, Level IV.

Keywords

scaphoid - fracture - proximal pole - screw - bone graft

Note

This work was performed at the Hospital for Special Surgery.

Ethical Approval

Institutional ethical board review approval was obtained from Hospital for Special Surgery's Institutional Review Board.

• References

• 1 Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980; 5 (05) 508-513
• 2 Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013; 38 (04) 690-700
• 3 Lim TK, Kim HK, Koh KH, Lee HI, Woo SJ, Park MJ. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting. J Hand Surg Am 2013; 38 (10) 1906-1912
• 4 Ramamurthy C, Cutler L, Nuttall D, Simison AJ, Trail IA, Stanley JK. The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid. J Bone Joint Surg Br 2007; 89 (05) 627-632
• 5 Kamrani RS, Zanjani LO, Nabian MH. Suture anchor fixation for scaphoid nonunions with small proximal fragments: report of 11 cases. J Hand Surg Am 2014; 39 (08) 1494-1499
• 6 Fowler JR, Ilyas AM. Headless compression screw fixation of scaphoid fractures. Hand Clin 2010; 26 (03) 351-361
• 7 Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996; 78 (12) 1829-1837
• 8 Korompilias AV, Lykissas MG, Kostas-Agnantis IP, Gkiatas I, Beris AE. An alternative graft fixation technique for scaphoid nonunions treated with vascular bone grafting. J Hand Surg Am 2014; 39 (07) 1308-1312
• 9 Adams JE, Steinmann SP. Acute scaphoid fractures. Orthop Clin North Am 2007; 38 (02) 229-235
• 10 Inoue G, Sakuma M. The natural history of scaphoid non-union. Radiographical and clinical analysis in 102 cases. Arch Orthop Trauma Surg 1996; 115 (01) 1-4
• 11 Düppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I. Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg Am 1994; 76 (02) 249-252
• 12 Capito AE, Higgins JP. Scaphoid overstuffing: the effects of the dimensions of scaphoid reconstruction on scapholunate alignment. J Hand Surg Am 2013; 38 (12) 2419-2425
• 13 Bushnell BD, McWilliams AD, Messer TM. Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. J Hand Surg Am 2007; 32 (06) 827-833
• 14 Imhof H, Sulzbacher I, Grampp S, Czerny C, Youssefzadeh S, Kainberger F. Subchondral bone and cartilage disease: a rediscovered functional unit. Invest Radiol 2000; 35 (10) 581-588
• 15 Poole AR. What type of cartilage repair are we attempting to attain?. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 40-44
• 16 Dodds SD, Panjabi MM, Slade III JF. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 2006; 31 (03) 405-413