Journal of Hand Surgery European - 2026-05-06 - Journal Article
Role of one- versus two-screw fixation of scaphoid fractures in contributing to nonunion and delayed union.
Jing C, Zirbes CF, Ralph JE, Mwangi J, Pidgeon TS, Hammert WC
Topics
Key Takeaway
Two-screw fixation of scaphoid fractures showed no significant difference in nonunion rate, time to union, or hardware complications compared to single-screw fixation in a propensity-matched cohort of 92 patients.
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Summary
This study asked whether two-screw fixation improves union rates and shortens time to union compared to single-screw fixation for surgically treated scaphoid fractures. After propensity score matching on demographics and Herbert classification, 92 patients were analyzed retrospectively. Nonunion rates, time to union, and hardware complications were statistically equivalent between groups, though wrist extension at 6 months was significantly greater in the one-screw cohort (71.0° vs. 56.2°, p=0.03).
Key Limitation
The retrospective design with a relatively small matched cohort (n=92) is underpowered to detect clinically meaningful differences in nonunion rates, which are low-frequency events requiring substantially larger samples.
Original Abstract
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.