Headless Compression Screw Fixation Alone for Lunate Coronal Fractures in Kienböck Disease

Lunate coronal fractures in Kienböck disease remain challenging to manage, and various reconstructive approaches have been described. The purpose of this study was to evaluate the outcomes of headless compression screw fixation alone in management of the lunate coronal fractures in Kienböck disease.

Twelve patients (seven females and five males; mean age 36.9 years) with lunate coronal fractures who underwent headless compression screw fixation between 2017 and 2025 were included in this retrospective study. Clinical and radiographic assessments were performed preoperatively and at final follow-up. The clinical evaluations included visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Modified Mayo Wrist (MMW) score, active range of motion, and grip strength. Radiographic parameters included the radioscaphoid angle, Ståhl index, and Nattrass index. Comparisons between preoperative and final follow-up continuous variables were performed using the paired t-tests or Wilcoxon signed-rank tests, as appropriate.

The median clinical follow-up was 56.8 months (range: 12-101 months). Radiographic follow-up was available in 11 patients, and the median imaging follow-up was 50.9 months (range: 12-99 months). One patient declined further imaging examinations due to complete symptom resolution. Among patients with available imaging, all coronal fractures achieved union. The average time to bone union was 7.6 ± 1.2 months. Significant improvements in wrist pain, QuickDASH score, MMW score, range of motion, and grip strength were observed after surgery. However, changes in radioscaphoid angle, Ståhl index, and Nattrass index showed no significant difference at final follow-up.

Headless compression screw fixation alone appears to be a reasonable treatment option for lunate coronal fractures in Kienböck disease in the absence of radiocarpal or midcarpal arthritis and without substantial lunate comminution.