Rethinking ORIF of the Scaphoid

Evidence tilts toward two screws rather than one

What’s the Claim?

The scaphoid is the only bone that we know of where, when broken, displacement as small as 1 mm confers a substantial risk of nonunion — and we’ve known that for a half a century. For that reason, over those 50 years or so, hand surgeons have never tired of trying to find better ways to fix these tough fractures.

The latest approach seems to be squeezing two cannulated compression screws in where possible, which makes good biomechanical sense, but reasonable people have wondered whether that’s practical in most or all fractures of this small bone.

A case series found that participating surgeons were able to place two parallel headless compression screws in all patients, though the parallel tracks were closer together (but still practical) in female patients; all 25 patients treated this way healed their fractures. Three patients had complications, including one whose proximal pole fracture propagated during placement of the second screw. The patient’s fracture healed without changing the duration of postoperative splinting, which in this series was about six weeks.

How’s It Stack Up?