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Acute Scaphoid Fracture Fixation With Two Headless Compression Screws

March 01, 2020

Contributors: Andy Chang, MD; Michael R Hausman, MD, FAAOS; Jaehon M Kim, MD, FAAOS; Eliseo DiPrinzio, MD

We use two 2.0-mm stainless steel headless compression screws for the fixation of acute scaphoid fractures, with the goal of more reliable and timely union because of increased biomechanical stability. For most acute scaphoid fractures without considerable deformity, we use a dorsal approach via a capsular incision made in line with the long axis of the scaphoid. The fracture is visualized, freshened, reduced, and held in place with the use of a pointed reduction clamp. The most technically demanding portion of the procedure is guidewire positioning to determine proper screw trajectory. The volar screw is position-limiting because of the dorsal rim of the distal radius. The wrist is hyperflexed, and the volar guidewire is inserted. The dorsal guidewire is placed approximately 3 mm dorsal and parallel to the volar guidewire. Ensure adequate bone stock is present in the proximal fragment to accept two threaded screw heads. The guidewires should be center-center in the coronal plane and just dorsal and volar to the central axis in the sagittal plane. The screws are sequentially tightened on insertion to prevent deformity or distraction at the fracture site. The wrist is immobilized for 6 weeks, followed by range-of-motion physical therapy or return to play. We achieved reliable fracture union in 100% of patients.