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Published March 15, 2022

Two-Screw Scaphoid Fixation for Proximal Pole Fractures

Introduction Although fractures of the proximal pole of the scaphoid have a higher rate of failure after fixation, biomechanical studies have shown two-screw constructs to be superior to single-screw constructs in rotational control, angular stability, and stiffness. In this video, we will discuss proximal pole fractures and evidence supporting two-screw fixation, and we will demonstrate our technique in an instructive case. Technique We use an open dorsal approach to the scaphoid and use of two 2.0-mm headless compression screws for fixation. The main technical points we will discuss include limited proximal bone stock, options for screw sizing, importance of the starting point, trajectory of screws, and pitfalls of propagating a fracture. Results Using this technique, we have performed 26 consecutive two-screw repairs for acute scaphoid fractures with a union rate of 100% to date. Conclusions Proximal pole scaphoid fractures can be difficult to treat. Instability and vascular supply contribute to a high rate of nonunion. Two-screw constructs may improve healing and allow earlier range of motion by increasing stability. Meticulous technique can allow uniform and safe placement of two screws in these challenging fractures.