J Korean Soc Surg Hand.  2013 Sep;18(3):111-117. 10.12790/jkssh.2013.18.3.111.

Headless Autocompression Screw Fixation of Scaphoid Fractures Using Open Dorsal Approach

• Kang HJ
• Won Y
• Kwon JW
• Koh IH
• Choi YR

• KMID: 2194140
• DOI: http://doi.org/10.12790/jkssh.2013.18.3.111

Abstract

PURPOSE
We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach.
METHODS
This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes.
RESULTS
After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion.
CONCLUSION
Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.

Keyword

Scaphoid fracture; Headless screw; Nonunion; Dorsal approach; Trans-scaphoid perilunate dislocation

MeSH Terms

Dislocations
Humans
Necrosis
Transplants

Figure

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  Fig. 1. (A) Preoperative radiograph shows nonunion of scaphoid. (B) Preoperative computed tomography (CT) shows a radiolucent lesion with sclerotic and cystic changes of proximal pole of scaphoid. (C) Harvesting autogenous radial bone for graft under primary skin incision. (D, E) Retrograde fixation of nonunion fragment with Herbert screw and autogenous bone graft. (F) One year after retrograde fixation follow-up CT shows complete radiologic union.

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  Fig. 2. (A, B) Preoperative radiograph show trans-scaphoid perilunar dorsal dislocation. (C) Preoperative computed tomography (CT) shows comminuted fracture lines on waist of scaphoid. (D, E) Open reduction and retrograde Using dorsal Herbert screw and a Kirschner's wire. (F) 1.5 year after retrograde fixation follow-up CT shows complete radiogic union.

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