Outcome of percutaneous screw fixation of scaphoid fractures

The optimal treatment of minimally displaced or nondisplaced fractures of the scaphoid is unclear. Traditionally, management of these fractures has been unpredictable with a significant risk of nonunion when treated conservatively. This study examined the results from 32 patients who underwent percutaneous screw fixation using a 3.0-mm AO/ASIF cannulated screw for a nondisplaced or minimally displaced fracture of the scaphoid waist. Eighteen patients were available for final follow up (average 3.2 years) including administration of the DASH questionnaire, a physical examination, and final radiographs. Sixteen (89%) healed successfully after the index procedure. There were two complications consisting of nonunions, both of which required revision open reduction and internal fixation for fracture union. These also went on to heal, resulting in an ultimate union rate of 100%. No significant differences were found between operative and nonoperative extremities with regard to radial-ulnar deviation arc of motion, grip, or pinch strength. The average DASH score was 7.4, indicating no disability. Percutaneous fixation of acute, nondisplaced scaphoid fractures with 3.0-mm AO/ASIF cannulated screw is a safe, effective technique that minimizes the need for long-term wrist immobilization, allows an expeditious return to vocational activity, and results in reliable rates of union.