Scaphoid Nonunions Treated With 2 Headless Compression Screws and Bone Grafting

Garcia, Ryan; Leversedge, Fraser J.; Aldridge, J. Mack; Richard, Marc J.; Ruch, David S.

doi:10.1016/j.jhsa.2014.02.030

Cited by 57 publications

(54 citation statements)

References 40 publications

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“…1 Current fixation options include the use of K-wires, single or double headless compression screws and plates. [5][6][7] We have previously compared biomechanically the latter three fixation options and have shown that both double screws and plate fixation provide significantly greater stability and stiffness, especially in rotation, when compared with single-screw fixation in a scaphoid nonunion model. 5 However, double screws and plate fixation showed no significant differences when compared, in any of the biomechanical parameters.…”

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confidence: 99%

“…In the literature, there has only been one previous study by Garcia et al that reported on the use of double screw fixation in a heterogeneous group of patients. 6 In their series, which combined scaphoid nonunions at various locations and the use of different bone grafting techniques, 100% of fractures went on to achieved radiological union, with good clinical outcomes.…”

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confidence: 99%

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Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss

Johnson²,

Bohan³

et al. 2020

J Wrist Surg

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Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15–38 years). The average time from initial injury was 16 months (range, 3–144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4–9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.

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confidence: 99%

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confidence: 99%

Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss

Johnson²,

Bohan³

et al. 2020

J Wrist Surg

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“…One potential disadvantage of a VTMPF without a corticocancellous bone graft for scaphoid nonunion might be the risk of scaphoid collapse. To decrease this risk and provide superior biomechanical stability of the construct, we performed the fixation with two headless compression screws (Garcia, Leversedge, Aldridge, Richard, & Ruch, ). This rigid fixation allowed the patient to initiate rehabilitation after only three weeks of immobilization, so that the patient attained 90% of the contralateral wrist's range of movement within two months of surgery.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report

et al. 2017

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“…These union rates were challenged by Barton 30 and Merrell et al 14 Recent reports of similar Russe modification involving wire fixation without screw placement have indicated 87% to 91% incidences of union, but the authors did not consider carpal realignment in their analysis. 31,32 Garcia et al 33 proposed a Russe modification using 2 headless screws along with an autograft struts, similarly emphasizing the importance of maintaining carpal stability and preventing scaphoid torsion. Although they reported unions in all 19 patients, the study lacked a quantitative analysis of intracarpal alignment.…”

Section: Discussionmentioning

confidence: 99%