Scaphoid fractures are the most common carpal bone injuries and remain clinically challenging due to retrograde vascular supply and risks of nonunion, malunion, and avascular necrosis. Surgical fixation is often preferred over conservative management for unstable, displaced, or proximal fractures, offering faster union and earlier functional recovery. This review outlines current fixation techniques, including Herbert and headless compression screws, plate fixation, and newer minimally invasive or hybrid methods. Headless compression screws provide interfragmentary compression, while plate fixation is particularly useful in complex or comminuted cases, though hardware irritation is a common drawback. Arthroscopy-assisted fixation reduces soft-tissue disruption and preserves vascularity, showing promising outcomes but requiring further long-term validation. Adjunctive methods such as bone grafting and emerging biomaterials, including bioabsorbable and allogeneic cortical bone screws, expand treatment options and may reduce complications related to metal hardware. Across studies, surgical fixation consistently demonstrates higher and faster union rates, improved early grip strength, and accelerated return to activity, particularly in high-demand populations. However, the literature is limited by small sample sizes, heterogeneous outcome measures, and a lack of long-term data. Future high-quality randomized controlled trials are needed to establish clearer evidence-based guidelines for optimal fixation strategies in scaphoid fracture management.
Kiwan et al. (Tue,) studied this question.