Single vs double headless compression screw fixation for scaphoid nonunion

doi:10.5312/wjo.124063

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Sep 18, 2026; 17(9): 124063
Published online Sep 18, 2026. doi: 10.5312/wjo.124063

Single vs double headless compression screw fixation for scaphoid nonunion

Suhaib Bani Essa, Yazan Anaqreh, Husam Matalqah, Abdulghfar Sammani, Mahmoud Abokhsab, Mohammad Zubi, Nizar Abu-Amoud, Yman Aldweik, Mutaz Abu-Eid, Ahmad Radaideh, Naser Obeidat

Suhaib Bani Essa, Yazan Anaqreh, Husam Matalqah, Abdulghfar Sammani, Mahmoud Abokhsab, Nizar Abu-Amoud, Yman Aldweik, Mutaz Abu-Eid, Ahmad Radaideh, Division of Orthopedic, Department of Special Surgery, Jordan University of Science and Technology, Irbid 22110, Jordan

Mohammad Zubi, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan

Naser Obeidat, Department of Diagnostic Radiology and Nuclear Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan

Author contributions: Bani Essa S and Anaqreh Y designed the research study, performed the statistical analysis, and wrote the original draft; Bani Essa S, Anaqreh Y, Matalqah H, Sammani A, Abokhsab M, Zubi M, Abu-Amoud N, Aldweik Y, Abu-Eid M, and Radaideh A acquired and curated the data; Bani Essa S, Anaqreh Y, and Obeidat N supervised the study; and all authors reviewed and edited the manuscript, interpreted the data, and approved the final version.

AI contribution statement: Grammarly was used for grammar checking and language refinement during manuscript preparation. No AI tools were used for content generation, data analysis, interpretation, or any scientific or intellectual aspects of the study.

Institutional review board statement: The study was approved by the Institutional Review Board of King Abdullah University Hospital.

Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Data are available from the corresponding author upon reasonable request. The data are not publicly available due to patient confidentiality and institutional data protection policies.

Corresponding author: Suhaib Bani Essa, MD, Assistant Professor, Division of Orthopedic, Department of Special Surgery, Jordan University of Science and Technology, Arramtha 3030, Irbid 22110, Jordan. smbaniessa@just.edu.jo

Received: June 8, 2026
Revised: July 21, 2026
Accepted: August 17, 2026
Published online: September 18, 2026
Processing time: 96 Days and 22.3 Hours

Abstract

BACKGROUND

Scaphoid nonunion remains a challenging problem, and the optimal fixation construct for surgical treatment is still debated. Although dual headless compression screw fixation may provide greater mechanical stability than single-screw fixation, clinical evidence comparing the two techniques with respect to patient-reported functional outcomes remains limited.

AIM

To compare the clinical, radiographic, and functional outcomes of single-screw vs dual-screw fixation for scaphoid nonunion, using the Disabilities of the Arm, Shoulder and Hand (DASH) score as the primary outcome measure and employing one-way analysis of covariance (ANCOVA) to control for baseline differences between groups. We hypothesized that dual-screw fixation would provide comparable or superior deformity correction and functional outcomes compared to single-screw fixation.

METHODS

This retrospective cohort study included patients with scaphoid waist nonunion treated surgically through a volar approach using a non-vascularized distal radius bone graft at King Abdullah University Hospital, Jordan, from August 2024 to August 2025. Patients with avascular necrosis, previous wrist surgery, vascularized grafts, grafts from sources other than the distal radius, or incomplete documentation were excluded. Twenty-three patients met the inclusion criteria: 15 treated with single-screw fixation and eight with double-screw fixation. Final outcome assessment was performed at six months and included DASH score, grip strength, wrist range of motion (ROM), time to union, and radiographic correction parameters. ANCOVA was performed to evaluate the independent effect of fixation method on DASH scores while controlling for age.

RESULTS

Baseline characteristics were comparable between the groups except for age, with the double-screw group being younger than the single-screw group (23.88 ± 7.30 years vs 32.80 ± 9.41 years; P = 0.030). Time to union was similar between the single- and double-screw groups (11.47 ± 3.38 weeks vs 11.13 ± 5.11 weeks; P = 0.849). Radiographic correction was also comparable, with no significant difference in change in height-to-length ratio or scapholunate angle between groups. Final grip strength did not differ significantly, although ROM showed a trend favoring double-screw fixation. The double-screw group demonstrated significantly better final DASH scores than the single-screw group (23.13 ± 11.40 vs 44.53 ± 21.39; P = 0.016). ANCOVA confirmed that the surgical group remained a significant independent predictor of final DASH scores after adjusting for age (F = 5.428, P = 0.030), while age did not exert a significant effect (F = 0.012, P = 0.915).

CONCLUSION

In this retrospective series of patients with scaphoid waist nonunion, double headless compression screw fixation was associated with superior patient-reported functional outcome compared with single-screw fixation, despite similar union time and radiographic correction. ANCOVA confirmed that this functional advantage was independent of the age difference between groups. These findings suggest that dual-screw fixation may offer a functional advantage in selected patients with scaphoid nonunion, although prospective randomized studies with larger sample sizes are needed to confirm these results.

Keywords: Scaphoid; Nonunion; Fixation; Screw; Outcome; Disabilities of the Arm; Shoulder and Hand

Core Tip: This retrospective cohort study of 23 patients with scaphoid waist nonunion found that double headless compression screw fixation yielded significantly better Disabilities of the Arm, Shoulder and Hand scores than single-screw fixation, despite comparable time to union and radiographic correction. These findings suggest dual-screw constructs may offer a functional advantage during rehabilitation, independent of anatomical restoration.