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
