The Journal of hand surgery, European volume · 2026
Role of one- versus two-screw fixation of scaphoid fractures in contributing to nonunion and delayed union.
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Jing Crystal, Zirbes Christian F, Ralph Julia E, Mwangi John, Pidgeon Tyler S, Hammert Warren C
Аннотация
INTRODUCTION: Displaced scaphoid fractures warrant surgical fixation to mitigate the risk of nonunion or malunion. We hypothesized that two-screw fixation would result in higher rates of union at shorter times.
METHODS: We retrospectively reviewed data of patients who presented with scaphoid fractures and underwent surgical fixation between 1 January 2013 and 30 November 2024. Patients were propensity score matched using demographics and Herbert classification as covariates.
RESULTS: After propensity score matching, 92 patients were identified, 47 receiving one screw and 45 receiving two screws. At 6 months after surgery, wrist extension was significantly greater in the one-screw cohort than in the two-screw cohort (71.0°, standard deviation (SD) 10.7° vs. 56.2°, SD 20.5°, p = 0.03); all other range of motion variables were similar between the cohorts at this timepoint. Visual analogue scale scores postoperatively significantly improved compared with preoperatively for both cohorts (p < 0.001 for both). Patients in the one-screw cohort showed significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function scores after surgery as compared with before surgery. The PROMIS PI scores in the two-screw cohort also showed significant differences after and before surgery. Rates of nonunion, time to union and hardware complications did not show statistically significant differences between the one- and two-screw cohorts.
CONCLUSION: In this study, we reject our hypothesis as two screws were similar to one-screw fixation for rates of healing and outcomes.
LEVEL OF EVIDENCE: III, case-control study.
METHODS: We retrospectively reviewed data of patients who presented with scaphoid fractures and underwent surgical fixation between 1 January 2013 and 30 November 2024. Patients were propensity score matched using demographics and Herbert classification as covariates.
RESULTS: After propensity score matching, 92 patients were identified, 47 receiving one screw and 45 receiving two screws. At 6 months after surgery, wrist extension was significantly greater in the one-screw cohort than in the two-screw cohort (71.0°, standard deviation (SD) 10.7° vs. 56.2°, SD 20.5°, p = 0.03); all other range of motion variables were similar between the cohorts at this timepoint. Visual analogue scale scores postoperatively significantly improved compared with preoperatively for both cohorts (p < 0.001 for both). Patients in the one-screw cohort showed significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function scores after surgery as compared with before surgery. The PROMIS PI scores in the two-screw cohort also showed significant differences after and before surgery. Rates of nonunion, time to union and hardware complications did not show statistically significant differences between the one- and two-screw cohorts.
CONCLUSION: In this study, we reject our hypothesis as two screws were similar to one-screw fixation for rates of healing and outcomes.
LEVEL OF EVIDENCE: III, case-control study.