Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Simon Sailer, Simon Lechner, Andreas Floßmann, Michael Wanzel, Kerstin Habeler, Christian Krasny, Gudrun H Borchert, Simon Sailer, Simon Lechner, Andreas Floßmann, Michael Wanzel, Kerstin Habeler, Christian Krasny, Gudrun H Borchert

Abstract

Background: Allograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union.

Patients and methods: We retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union.

Results: Using the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94-96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate.

Conclusion: Using the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures-but better union rates in pseudarthrosis patients-compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars.

Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

Keywords: Delayed union; Human allogeneic cortical bone screw; Multicenter retrospective study; Proximal pole; Pseudarthroses; Scaphoid fracture; Shark Screw®; Union rate.

Conflict of interest statement

Simon Sailer is an instructor for Surgebright, GmbH. The other authors had no competing interests to declare.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Bone screw and surgical procedure. A Example of the cortical bone screw. B The Shark Screw® "cut" is screwed in, without much resistance, with a hexagonal screwdriver. C The skin incision was pulled proximally with a narrow-wound hook and, at the same time, the wrist was bent so that the protruding material of the cortical bone screw could be sawn off just above the bone surface in a subsequent step
Fig. 2
Fig. 2
Fresh scaphoid fracture in the middle third. A Pre-surgery. B 8 weeks post-surgery; C 16 months post-surgery
Fig. 3
Fig. 3
Fresh scaphoid fracture in the proximal pole. A Pre-surgery. B 1 day post-surgery. C 12 months post-surgery
Fig. 4
Fig. 4
Pseudarthrosis of the scaphoid in the middle third. A Pre-surgery. B 14 days post-surgery. C 27 months post-surgery
Fig. 5
Fig. 5
Pseudarthrosis of the scaphoid in the proximal pole. A Pre-surgery, Inset: CT of the scaphoid. B 1 day post-surgery. C 10 months post-surgery. Inset: CT of the scaphoid
Fig. 6
Fig. 6
Example of cysts pre-surgery. Pseudarthrosis patient with a fracture in the middle third. A Pre-surgery. Inset: CT with good visibility of the cysts. B 1-day post-surgery. C 17 months post-surgery; no cysts are visible
Fig. 7
Fig. 7
Example of nonunion. The patient had pseudarthrosis of the scaphoid in the middle third. A Pre-surgery. B 6 weeks post-surgery. The screw was not placed deep enough into the proximal pole. C 16 months post-surgery. The screw was fully integrated in the bone, but union was not achieved. Re-operation is scheduled
Fig. 8
Fig. 8
Kaplan–Meier curve for time to union: only patients with unions are included. Patients are divided into those with a fresh fracture (time between injury and surgery was  6 months, PS). The vertical dotted line is included to facilitate reading the figure at 200 days

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