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J Wrist Surg
DOI: 10.1055/a-2702-0158
Scientific Article

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

Authors

  • Jacob Vaughn 

    1   Department of Orthopedic Surgery of the State University of New York Upstate University Hospital, Syracuse, New York, United States

  • Conor Lynch

    1   Department of Orthopedic Surgery of the State University of New York Upstate University Hospital, Syracuse, New York, United States

  • Taylor Willenbring

    1   Department of Orthopedic Surgery of the State University of New York Upstate University Hospital, Syracuse, New York, United States

  • Zachary Telgheder

    1   Department of Orthopedic Surgery of the State University of New York Upstate University Hospital, Syracuse, New York, United States

  • Brian Harley

    1   Department of Orthopedic Surgery of the State University of New York Upstate University Hospital, Syracuse, New York, United States
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Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusion

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.

Level of Evidence

Therapeutic Level IV.

Keywords

autograft - nonunion - repair - scaphoid - headless screw

Informed Consent

This study was performed under the guidance of the SUNY Upstate Institutional Review Board and was granted an exempt status according to their standards and review process.




Publication History

Received: 27 April 2025

Accepted: 15 September 2025

Article published online:
03 October 2025

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