Screw and K Wire Fixation in Scaphoid Nonunion
Objective: Attainment of healing in scaphoid nonunion may be unpredictable, requiring stabilization as well as bone grafting. Despite intramedullary screw fixation, instability may still hamper union. The purpose of this study was to describe the addition of Kirschner wires (KWs) through the capitate and lunate to supplement an intramedullary screw for temporary enhanced stability and possible control of ligamentous forces.
Methods: A case-control study was performed reviewing 44 cases of scaphoid nonunion. Charts were reviewed for demographic data, time to union and complications.
All patients were treated surgically with bone grafting from the distal radius as well as an intramedullary screw. Twenty-five patients were treated with additional KWs, 19 with only a screw. Three scaphoids failed to unite.
Results: All patients were male with an average age of 26.9(8.0). There were no differences in population characteristics, fracture characteristics or outcome measures between patients treated with KWs and a screw and those treated with a screw alone. We had no complications related to the addition of KWs. Three scaphoids failed to unite. Time to union was not significantly different between the groups.
Conclusions: This study presents an alternative method of fixation for unstable scaphoid nonunions. Although this study did not show superiority of either method, we demonstrated that using KWs as an adjunct to screw fixation is safe and does not incur complications. Addition of KWs may be considered in complex scaphoid nonunion with instability.