Cannulated compression screw with versus without two K-wire fixation for treatment of scaphoid waist fracture nonunion

PURPOSE: This study aims to introduce the “tripod” technique using cannulated compression screw and two anti-rotational K-wires for treatment of unstable scaphoid waist fracture nonunion, and to compare it with the single cannulated screw fixation technique in term of scaphoid union and surgical outcomes. METHODS: It was a retrospective study. From January 2014 to March 2020, 103 consecutive patients with scaphoid waist fracture nonunion treated with the tripod fixation and bone grafting (n = 45) or with single cannulated compression screw and bone grafting (n = 58) were included. All the procedures were performed by the same hand surgery team, and autologous cortico-cancellous radius bone graft was used for bony reconstruction. The minimal follow-up period was 12 months. The union rate and the time to union, range of motion (ROM), grip strength, Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) score and modified Mayo Scores at the last visit were compared. RESULTS: In tripod fixation group, bony union was achieved in all patients at the mean of 14.8 ± 3.8 weeks, while in the single cannulated screw fixation group the bony union rate was 94.8% (55/58) and the time to union was 17.6 ± 3.6 weeks. The difference of time to union was statistically significant (p = 0.027), but not for bony union rate (p = 0.122). At the last visit, no significant difference was found with respect to any clinical and radiographic outcome measures (all p > 0.05). The overall rate of complications was not significantly different between two groups (15.6% vs 10.3%, p = 0.430). CONCLUSIONS: Tripod fixation technique with headless compression screw and two K-wires is a safe and effective technique for treatment of scaphoid nonunion fixation and can be considered to use in practice, especially for those potentially rotationally unstable cases.