Robotic-assisted vs Freehand Scaphoid Screw Fixation in Acute Scaphoid Fractures: A Systematic Review and Meta-analysis

Abstract

Introduction: Accurate screw fixation of scaphoid fractures is essential for optimal healing and restoration of wrist function. Scaphoid fractures represent 50–80% of all carpal bone fractures and constitute about 3% of wrist fractures overall. The yearly incidence is approximately 29 cases per 100,000 people, predominantly affecting young adults. Robotic-assisted surgical techniques have been developed to enhance placement accuracy and reduce radiation exposure when compared to conventional freehand methods. Purpose: The review aims to explore whether Robotic-Assisted is better than Freehand Technique for Scaphoid Screw Fixation in Acute Scaphoid Fracture Cases. Materials and Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the Cochrane Handbook. Two independent reviewers searched PubMed, Embase, the Cochrane Library, and Web of Science up to May 2025. The included studies comprised one randomised controlled trial and one retrospective cohort study, involving a total of 54 patients. A non-comparative group study design was done. Risk of bias was assessed using the ROB 2 and ROBINS-I tools. Evaluated outcomes included operative time, fluoroscopy usage, screw placement accuracy, complications, fracture union, and wrist function measured using the Mayo Modified Wrist Score. Accuracy of screw placement was assessed quantitatively in the robotic groups of both studies, either by software-calculated deviation (RCT) or post-operative CT angular analysis (cohort). Results: The study found no significant difference in Mayo scores (Z = 0.35, P = 0.73) with heterogeneity was moderate (Chi² = 1.69, I² = 41%, P = 0.19), or operative time (Z = 0.04, P = 0.97) with very high heterogeneity among the studies (Chi² = 41.18, P < 0.00001; I² = 98%), between robotic-assisted and freehand techniques. Robotic fixation showed slightly higher Mayo scores but longer operative times. Statistical analyses revealed wide confidence intervals and high heterogeneity, indicating variability and uncertainty in pooled results across the included studies. Discussions: Robotic-assisted screw fixation offers improved placement precision and lower intraoperative radiation exposure, indicating technical superiority over the freehand method. However, these technical advantages did not translate into superior clinical outcomes. Conclusions: Robotic-assisted scaphoid fixation showed trends toward better accuracy, lower radiation, and fewer attempts, but differences were not statistically significant. Clinical outcomes were similar between techniques. While robotic systems offer technical precision, their superiority remains unproven. Larger studies with longer follow-up are needed to confirm potential long-term advantages.