Enhanced scaphoid fixation with Kirschner wire: A clinical and finite element study

This study aims to assess the effect of addition of a Kirschner wire (K-wire) to a headless compression screw on biomechanical and clinical outcomes in the treatment of scaphoid fractures and nonunions.

Between January 2020 and November 2023, a total of 23 patients (20 males, 3 females; mean age: 29.7±7.2 years; range, 18 to 43 years) who underwent surgical treatment for scaphoid fractures and nonunion were retrospectively analyzed. The patients were divided into two groups: those who received only a headless compression screw (Group 1), and those who received both a screw and a supplementary K-wire, which was removed after three months (Group 2). In cases of nonunion, autografting was also performed. Postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS), Mayo Wrist Score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Finite element analysis was conducted to assess the biomechanical performance of both fixation methods.

Patients treated with screw combined with the K-wire demonstrated significantly improved postoperative functional scores and lower pain levels compared to those treated with screw alone (p=0.011 for VAS, p=0.027 for Mayo Wrist Score and p=0.009 for QuickDASH). Finite element analysis revealed a reduction in stress concentration at the fracture site in the screw + K-wire group.

The addition of a K-wire to screw fixation seems to enhance biomechanical stability and clinical outcomes in scaphoid fractures. These findings suggest that K-wire augmentation may be a beneficial strategy for improving healing and reducing postoperative discomfort.