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
