Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

Surgical treatment of scaphoid nonunion is not always successful, often requiring stabilization and bone grafting to achieve healing. Even after intramedullary screw fixation, residual instability may still hinder union. The purpose of this study was to describe the addition of Kirschner wires (KWs) through the capitate and the lunate to supplement an intramedullary screw for temporary enhanced stability, possibly improving healing of unstable fractures. A case-control study reviewing 25 cases with addition of KWs and 19 controls was performed. Demographic and fracture information, time to diagnosis, and healing time were documented. We found no differences in population characteristics, fracture characteristics, or outcome measures between patients treated with this method and those treated with a screw alone. We had no complications related to the addition of KWs. Preoperative lunate type and scapholunate gapping was suggestive but not significantly associated with KW insertion. Addition of KWs is safe and may be considered in scaphoid nonunion in the presence of intraoperative suboptimal stability. Intraoperative stability may possibly be inferred by reviewing preoperative radiographs for signs of instability.