Jnl Wrist Surg 2016; 05(01): 071-076
DOI: 10.1055/s-0035-1565928
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scaphoid Proximal Pole Fracture Following Headless Screw Fixation

Schneider K. Rancy
1  Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Jonathan A. Zelken
1  Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Joseph D. Lipman
2  Department of Biomechanics, Hospital for Special Surgery, New York, New York
,
Scott W. Wolfe
1  Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

24 September 2015

26 September 2015

Publication Date:
21 November 2015 (online)

Abstract

Background Headless screw fixation of scaphoid fractures and nonunions yields predictably excellent outcomes with a relatively low complication profile. However, intramedullary implants affect the load to failure and stress distribution within bone and may be implicated in subsequent fracture.

Case Description We describe a posttraumatic fracture pattern of the scaphoid proximal pole originating at the previous headless screw insertion site in three young male patients with healed scaphoid nonunions. Each fracture was remarkably similar in shape and size, comprised the volar proximal pole, and was contiguous with the screw entry point. Treatment was challenging but successful in all cases.

Literature Review Previous reports have posited that stress-raisers secondary to screw orientation may be implicated in subsequent peri-implant fracture of the femoral neck. Repeat scaphoid fracture after screw fixation has also been reported. However, the shape and locality of secondary fracture have not been described, nor has the potential role of screw fixation in the production of distinct fracture patterns.

Clinical Relevance Hand surgeons must be aware of this difficult complication that may follow antegrade headless screw fixation of scaphoid fracture nonunion, and of available treatment strategies.