J 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.

 
  • References

  • 1 Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am 2001; 83-A (4) 483-488
  • 2 Kawamura K, Chung KC. Treatment of scaphoid fractures and nonunions. J Hand Surg Am 2008; 33 (6) 988-997
  • 3 Arora R, Gschwentner M, Krappinger D, Lutz M, Blauth M, Gabl M. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg 2007; 127 (1) 39-46
  • 4 Vinnars B, Pietreanu M, Bodestedt A, Ekenstam Fa, Gerdin B. Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am 2008; 90 (6) 1176-1185
  • 5 Davis EN, Chung KC, Kotsis SV, Lau FH, Vijan S. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg 2006; 117 (4) 1223-1235 , discussion 1236–1238
  • 6 Rettig ME, Kozin SH, Cooney WP. Open reduction and internal fixation of acute displaced scaphoid waist fractures. J Hand Surg Am 2001; 26 (2) 271-276
  • 7 Slade III JF, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 20-32
  • 8 Yip HS, Wu WC, Chang RY, So TY. Percutaneous cannulated screw fixation of acute scaphoid waist fracture. J Hand Surg [Br] 2002; 27 (1) 42-46
  • 9 Sanders WE. Evaluation of the humpback scaphoid by computed tomography in the longitudinal axial plane of the scaphoid. J Hand Surg Am 1988; 13 (2) 182-187
  • 10 Mathoulin C, Haerle M. Vascularized bone graft from the palmar carpal artery for treatment of scaphoid nonunion. J Hand Surg [Br] 1998; 23 (3) 318-323
  • 11 Oakey JW, Stover MD, Summers HD, Sartori M, Havey RM, Patwardhan AG. Does screw configuration affect subtrochanteric fracture after femoral neck fixation?. Clin Orthop Relat Res 2006; 443 (443) 302-306
  • 12 Lichtblau S, Gallina J, Nasser P, Munyoki M, Jepsen K. A biomechanical comparison of two patterns of screw insertion. Bull NYU Hosp Jt Dis 2008; 66 (4) 269-271
  • 13 Riester JN, Baker BE, Mosher JF, Lowe D. A review of scaphoid fracture healing in competitive athletes. Am J Sports Med 1985; 13 (3) 159-161
  • 14 Toby EB, Butler TE, McCormack TJ, Jayaraman G. A comparison of fixation screws for the scaphoid during application of cyclical bending loads. J Bone Joint Surg Am 1997; 79 (8) 1190-1197
  • 15 Carter II FM, Zimmerman MC, DiPaola DM, Mackessy RP, Parsons JR. Biomechanical comparison of fixation devices in experimental scaphoid osteotomies. J Hand Surg Am 1991; 16 (5) 907-912
  • 16 Kaulesar Sukul DM, Johannes EJ, Marti RK, Klopper PJ. Biomechanical measurements on scaphoid bone screws in an experimental model. J Biomech 1990; 23 (11) 1115-1121
  • 17 Takase K, Yamamoto K. Mechanical strength and optimal site of placement of a threaded bone screw assessed on the basis of the screw breakage for non-union of the scaphoid: a biomechanical study. Hand Surg 2005; 10 (2–3) 225-230
  • 18 Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996; 78 (12) 1829-1837
  • 19 Guo Y, Tian GL, Jiang BG, Chen SL, Han N. Central placement of screw fixation for scaphoid fracture: a biomechanical study [in Chinese]. Beijing Da Xue Xue Bao 2013; 45 (5) 684-687
  • 20 Dodds SD, Panjabi MM, Slade III JF. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 2006; 31 (3) 405-413
  • 21 McCallister WV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am 2003; 85-A (1) 72-77