Abstract
Introduction:Scaphoid fractures are most often treated with a single headless compression screw. However, intercarpal Kirschner wire (K-wire) might be added to improve stability and fracture outcomes. This study will determine if there is a difference in treatment outcome (union rate and time to union) between scaphoid fracture fixations using a single headless compression screw with and without augmentation using a intracarpal intramedullary K-wire.Material and Methods:We conducted a retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15 years period from December 2000 to December 2015. Only patients who underwent open surgery with bone grafting were included. They were divided into a group treated with a single screw fixation, and another group treated with screw and K-wire fixations.Results:Forty-four (58.7%) patients had single screw fixation and 31 (41.3%) had screw augmented with K-wire fixation. The overall union rate was 88.0%, with an overall mean time to union of 5.3 months. There was no difference in union rate (p=0.84) and time to union (p=0.66) between the single screw group and combined screw and K-wire group. Univariate analysis found that older age (t=-2.11, p=0.04) had a significant effect on union rate. Regression model showed that age had a significant effect on months to union.Conclusion:In open fixation of scaphoid fractures with compression screw and bone grafting, union rate and time to union is comparable whether or not screw fixation was augmented with an intracarpal K-wire. There was no increased risk of complications associated with augmented screw. Age of patient affected time to union and union rate.
Highlights
Scaphoid fractures are most often treated with a single headless compression screw
There was no statistical difference in union rate and time to union between the single screw group, and augmented screw group
Age had a significant effect on union rate using univariate analysis (t=-2.11, p=0.04)
Summary
The study was approved by the hospital’s ethics committee (CIRB, 2012/870/D). A retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15year period from December 2000 to December 2015 were identified using hospital records. Chi square and Fisher’s exact test (if count less than 4) were for categorical outcome variables This was to check for any differences in socio-demographic data between both groups at baseline. Chi square test and odds ratio were used to compare union rate, which was a categorical data. There were no differences in the demographic, radiographic, and operative data between both groups (Table I). Mean time to union for single screw was 5.2 months, and 5.7 months for combined screw and K-wire. There was no statistical difference in union rate and time to union between the single screw group, and augmented screw group. The follow-up duration in the single screw group and the augmented screw group was 12.7 months and 17.2 months, respectively, but the difference was not significant (p=0.17).
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