Shagun Cares® Compression Screw are implanted dorsally for scaphoid fractures of the proximal pole and implanted volarly for distal pole fractures, because this permits maximum fracture compression.¹⁵ Fractures of the waist may be fixed from a dorsal or volar approach as long as the screw is implanted along the central scaphoid axis. Blunt dissection along the guidewire exposes a tract to the dorsal wrist capsule and scaphoid base. Before drilling, the guidewire should be advanced so that both ends are exposed equally . This will permit the wire from becoming dislodged during reaming. The scaphoid is prepared by hand drilling the scaphoid cortex with a cannulated hand drill. This allows the implantation of a headless compression screw completely within the scaphoid. The screw is advanced under fluoroscopic guidance to within 1 to 2 mm of the opposite cortex with excellent compression. If the screw is advanced to the distal cortex, attempts to advance the screw farther will displace or penetrate the distal fragment. With unstable fractures, a joystick is left in the distal scaphoid fragment for screw implantation. As the screw is implanted, a counterforce is exerted through the joystick, compressing both fracture fragments and ensuring rigid fixation.

After Compression Screw placement, the guidewire is removed and wrist fluoroscopy confirms screw position, fracture reduction, and rigid fixation. Arthroscopy can also confirm reduction and complete seating of the screw.

Occasionally, as in the case presented, the unstable nature of the fracture requires additional fixation (screw and supplemental K-wires or two screws)