Proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws

Background Scaphoid excision and limited intercarpal fusion is a common surgical procedure performed for degenerative disorders of the wrist including scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist deformities. Postoperative screw migration is a rare but devastating complication that can result in severe degenerative changes in the radiocarpal joint. Questions/Purposes The purpose of this study is to report on a series of patients who developed proximal migration of their hardware following limited intercarpal fusions with headless compression screws. Patients and Methods Four patients were identified between 2001 and 2012 who were indicated for and underwent scaphoid excision and midcarpal fusions with headless compression screw fixation and subsequently developed hardware migration with screw protrusion into the radiocarpal joint. Detailed chart review was performed. Results Mean age at surgery was 64 years (57-69 years). All patients had the diagnosis of SLAC wrist. Mean time to detection of failure was 6 months (4-8 months). All patients demonstrated radiographic union prior to failure based on plain films. Radiographs revealed screw backout with erosion of the radial lunate facet in all patients. Calculated carpal height ratios demonstrated a drop from an average 44.2% to 39.5% at the time of hardware migration. All four patients underwent hardware removal. One patient was not indicated for any further surgery, and two patients underwent further revision surgery. All three patients reported complete pain relief. One patient refused a salvage procedure and had subsequent persistent pain. Conclusions This study reports a serious complication of scaphoid excision and midcarpal fusion performed with headless compression screws. We advise surgeons to be aware of this potential complication and consider employing methods to reduce the risk of hardware migration. Additionally, we recommend at least 8 months of clinical and radiographic follow-up postoperatively to enable early intervention if necessary. Level of Evidence Level IV, therapeutic study.