Download PDF
J Wrist Surg 2021; 10(03): 255-261
DOI: 10.1055/s-0040-1721405
Survey or Meta-analysis

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

Duncan S. Van Nest 
1   Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Michael Reynolds
1   Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Eugene Warnick
1   Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Matthew Sherman
1   Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Asif M. Ilyas
1   Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions.

Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions.

Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution.

Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores.

Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.

Keywords

scaphoid - nonunion - headless screws - volar plate


Publication History

Received: 08 September 2020

Accepted: 19 October 2020

Article published online:
03 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Grover R. Clinical assessment of scaphoid injuries and the detection of fractures. J Hand Surg [Br] 1996; 21 (03) 341-343
    CrossrefPubMedGoogle Scholar
  • 2 Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci 2006; 11 (04) 424-431
    CrossrefPubMedGoogle Scholar
  • 3 Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980; 5 (05) 508-513
    CrossrefPubMedGoogle Scholar
  • 4 Langhoff O, Andersen JL. Consequences of late immobilization of scaphoid fractures. J Hand Surg [Br] 1988; 13 (01) 77-79
    CrossrefPubMedGoogle Scholar
  • 5 Gellman H, Caputo RJ, Carter V, Aboulafia A, McKay M. Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid. J Bone Joint Surg Am 1989; 71 (03) 354-357
    CrossrefPubMedGoogle Scholar
  • 6 Pao VS, Chang J. Scaphoid nonunion: diagnosis and treatment. Plast Reconstr Surg 2003; 112 (06) 1666-1676 , quiz 1677, discussion 1678–1679
    CrossrefPubMedGoogle Scholar
  • 7 Rhee PC, Jones Jr DB, Shin AY, Bishop AT. Evaluation and treatment of scaphoid nonunions: a critical analysis review. JBJS Rev 2014; 2 (07) 01874474-201402070-00006
    PubMedGoogle Scholar
  • 8 Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 1984; 66 (01) 114-123
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Ender HG. A new method of treating traumatic cysts and pseudoarthrosis of the scaphoid (author's transl) [in German]. Unfallheilkunde 1977; 80 (12) 509-513
    PubMedGoogle Scholar
  • 11 Leixnering M, Pezzei C, Weninger P. et al. First experiences with a new adjustable plate for osteosynthesis of scaphoid nonunions. J Trauma 2011; 71 (04) 933-938
    CrossrefPubMedGoogle Scholar
  • 12 Talia AJ, Fraval A, Halliday L, McKie G, Paiva J, Thai DM. Scaphoid specific volar locking plate and non-vascularised iliac crest bone graft in scaphoid non-union. A comparative cohort study. J Orthop 2019; 16 (04) 337-341
    CrossrefPubMedGoogle Scholar
  • 13 Jurkowitsch J, Dall'Ara E, Quadlbauer S. et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg 2016; 136 (11) 1623-1628
    CrossrefPubMedGoogle Scholar
  • 14 Burgos FH, Nakamoto JC, Nakamoto HA. Iwase FDC, Mattar R. Treatment of scaphoid nonunion with volar locked plate. Acta Ortop Bras 2019; 27 (03) 141-145
    CrossrefPubMedGoogle Scholar
  • 15 Esteban-Feliu I, Barrera-Ochoa S, Vidal-Tarrason N, Mir-Simon B, Lluch A, Mir-Bullo X. Volar plate fixation to treat scaphoid nonunion: a case series with minimum 3 years of follow-up. J Hand Surg Am 2018; 43 (06) 569.e1-569.e8
    CrossrefPubMedGoogle Scholar
  • 16 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 (05) 336-341
    CrossrefPubMedGoogle Scholar
  • 17 Mahmoud M, Koptan W. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. J Bone Joint Surg Br 2011; 93 (07) 932-936
    CrossrefPubMedGoogle Scholar
  • 18 Gurger M, Yilmaz M, Yilmaz E, Altun S. Volar percutaneous screw fixation for scaphoid nonunion. Niger J Clin Pract 2018; 21 (03) 388-391
    CrossrefPubMedGoogle Scholar
  • 19 Morris MS, Zhu AF, Ozer K, Lawton JN. Proximal pole scaphoid nonunion reconstruction with 1,2 intercompartmental supraretinacular artery vascularized graft and compression screw fixation. J Hand Surg Am 2018; 43 (08) 770.e1-770.e8
    CrossrefPubMedGoogle Scholar
  • 20 Somerson JS, Fletcher DJ, Srinivasan RC, Green DP. Compression screw fixation without bone grafting for scaphoid fibrous nonunion. Hand (N Y) 2015; 10 (03) 450-453
    CrossrefPubMedGoogle Scholar
  • 21 Garcia RM, Leversedge FJ, Aldridge JM, Richard MJ, Ruch DS. Scaphoid nonunions treated with 2 headless compression screws and bone grafting. J Hand Surg Am 2014; 39 (07) 1301-1307
    CrossrefPubMedGoogle Scholar
  • 22 Cohen MS, Jupiter JB, Fallahi K, Shukla SK. Scaphoid waist nonunion with humpback deformity treated without structural bone graft. J Hand Surg Am 2013; 38 (04) 701-705
    CrossrefPubMedGoogle Scholar
  • 23 Sander AL, Sommer K, Schäf D. et al. Clinical outcome after alternative treatment of scaphoid fractures and nonunions. Eur J Trauma Emerg Surg 2018; 44 (01) 113-118
    CrossrefPubMedGoogle Scholar
  • 24 Quadlbauer S, Pezzei C, Beer T. et al. Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg 2019; 139 (02) 281-293
    CrossrefPubMedGoogle Scholar
  • 25 Altay T, Gunal I, Kayali C, Sener M. Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures: decision making with MRI. Int Orthop 2014; 38 (05) 1007-1010
    CrossrefPubMedGoogle Scholar
  • 26 Gereli A, Nalbantoglu U, Sener IU, Kocaoglu B, Turkmen M. Comparison of headless screws used in the treatment of proximal nonunion of scaphoid bone. Int Orthop 2011; 35 (07) 1031-1035
    CrossrefPubMedGoogle Scholar
  • 27 Ritter K, Giachino AA. The treatment of pseudoarthrosis of the scaphoid by bone grafting and three methods of internal fixation. Can J Surg 2000; 43 (02) 118-124
    PubMedGoogle Scholar
  • 28 Poggetti A, Rosati M, Castellini I. et al. Treatment of scaphoid waist nonunion using olecranon bone graft and Stryker Asnis micro cannulated screw: a retrospective study-80 case studies and 6 years of follow-up. J Wrist Surg 2015; 4 (03) 194-199
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Papatheodorou LK, Sotereanos DG. Treatment for proximal pole scaphoid nonunion with capsular-based vascularized distal radius graft. Eur J Orthop Surg Traumatol 2019; 29 (02) 337-342
    CrossrefPubMedGoogle Scholar
  • 30 Putnam JG, Mitchell SM, DiGiovanni RM, Stockwell EL, Edwards SG. Outcomes of unstable scaphoid nonunion with segmental defect treated with plate fixation and autogenous cancellous graft. J Hand Surg Am 2019; 44 (02) 160.e1-160.e7
    CrossrefPubMedGoogle Scholar
  • 31 Putnam JG, DiGiovanni RM, Mitchell SM, Castañeda P, Edwards SG. Plate fixation with cancellous graft for scaphoid nonunion with avascular necrosis. J Hand Surg Am 2019; 44 (04) 339.e1-339.e7
    CrossrefPubMedGoogle Scholar
  • 32 Dodds SD, Halim A. Scaphoid plate fixation and volar carpal artery vascularized bone graft for recalcitrant scaphoid nonunions. J Hand Surg Am 2016; 41 (07) e191-e198
    CrossrefPubMedGoogle Scholar
  • 33 Dodds SD, Williams JB, Seiter M, Chen C. Lessons learned from volar plate fixation of scaphoid fracture nonunions. J Hand Surg Eur Vol 2018; 43 (01) 57-65
    CrossrefPubMedGoogle Scholar
  • 34 Ghoneim A. The unstable nonunited scaphoid waist fracture: results of treatment by open reduction, anterior wedge grafting, and internal fixation by volar buttress plate. J Hand Surg Am 2011; 36 (01) 17-24
    CrossrefPubMedGoogle Scholar
  • 35 Mehling IM, Arsalan-Werner A, Wingenbach V, Seegmüller J, Schlageter M, Sauerbier M. Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 2019; 139 (08) 1161-1169
    CrossrefPubMedGoogle Scholar
  • 36 Schormans PMJ, Brink PRG, Poeze M, Hannemann PFW. Angular stable miniplate fixation of chronic unstable scaphoid nonunion. J Wrist Surg 2018; 7 (01) 24-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Merrell GA, Wolfe SW, Slade III JF. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am 2002; 27 (04) 685-691
    CrossrefPubMedGoogle Scholar
  • 38 Christodoulou LS, Kitsis CK, Chamberlain ST. Internal fixation of scaphoid non-union: a comparative study of three methods. Injury 2001; 32 (08) 625-630
    CrossrefPubMedGoogle Scholar
  • 39 DeGeorge Jr BR, Shin AY. Volar approach to percutaneous fixation of acute nondisplaced fractures of the scaphoid. Tech Hand Up Extrem Surg 2019; 23 (01) 6-9
    CrossrefPubMedGoogle Scholar
  • 40 Quadlbauer S, Pezzei C, Jurkowitsch J. et al. Palmar angular stable plate fixation of nonunions and comminuted fractures of the scaphoid [in German]. Oper Orthop Traumatol 2019; 31 (05) 433-446
    CrossrefPubMedGoogle Scholar
  • 41 Grewal R, Suh N, Macdermid JC. Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively. J Hand Surg Am 2013; 38 (05) 872-877
    CrossrefPubMedGoogle Scholar