Nitinol Compression Staple Versus Headless Compression Screw Fixation for Scaphoid Waist Fractures

There are a variety of ways to surgically manage patients with scaphoid waist fractures. The purpose of this study is to compare the rate of union achieved with a nitinol compression staple versus that of a headless compression screw in the treatment of scaphoid waist fractures.

We performed a retrospective review of patients with middle-third scaphoid fractures treated surgically. Patients were stratified into 2 groups based on fixation device: a nitinol compression staple or headless compression screw (HCS). Primary outcome was radiographic union. Secondary outcomes included time from surgery to union, development of avascular necrosis (AVN), complication rate, and need for revision.

Forty-one patients were included in the final analysis. The median follow-up time was 5.7 months. Twenty patients were treated with staples, 21 with HCS. Thirty-seven patients achieved union. All who failed to unite were treated with HCS. Eight patients had postoperative complications, including postoperative AVN, all of whom were in the HCS cohort. This treatment group had a higher rate of revision surgery as well. Staples required less time to achieve union and fewer weeks of immobilization. Postoperative scapholunate angles were similar between the groups.

Fixation of scaphoid waist fracture with nitinol compression staples is at least as likely to achieve union as fixation with HCS in patients without prior surgical intervention. This treatment also demonstrated equivalent or better secondary outcomes, including postoperative AVN, complication and revision rates, time to union, and weeks immobilized.