J Korean Fract Soc.  2009 Apr;22(2):104-109. 10.12671/jkfs.2009.22.2.104.

Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture

• Kim JK
• Kim JO
• Lee SY
• Do NH

• KMID: 1470023
• DOI: http://doi.org/10.12671/jkfs.2009.22.2.104

Abstract

PURPOSE: To report the surgical results of volar percutaneous cannulated compression screw fixation in subacute scaphoid fracture.
MATERIALS AND METHODS
Between January 2004 and January 2007, eight consecutive patients with subacute scaphoid waist fracture, who sought medical attention between 4 weeks to 6 months after injury, were included in this study. All patients were male of an average age 29.2 years (range, 19 to 44). Mean duration of injury was 10.3+/-4.1 weeks. An acutrak cannulated screw (Acumed, Hillsboro, OR) was introduced volarly under image intensifier guidance in all patients. We performed radiological evaluation preoperatively and postoperatively. And we performed 12 months postoperatively using grip strength, range of motion (ROM) of the wrist, Mayo Modified Wrist Score (MMWS) and Disabilities of the Arm, Shoulder and the Hand (DASH) score for functional evaluation.
RESULTS
Preoperative radiography showed minimal sclerosis line in three patients and a bone resorption around fracture sites in two patients. However, no patient had dorsal intercalated segment instability or more than 35 degrees of lateral intrascaphoid angle. Fractures united successfully at 11.6+/-2.1 weeks postoperatively without any requirement for a further procedure. At 12 months follow-up evaluations, ROM of the injured wrist was 93% of the uninjured wrist and grip strength of the injured wrist was 95% of the injured wrist. The mean MMWS was 93+/-6.6 and the mean DASH score was 4.8+/-1.2.
CONCLUSION
We believe that volar percutaneous cannulated screw fixation is a reliable method in case of subacute scaphoid waist fracture without scaphoid deformity or carpal instability.

Keyword

Subacute scaphoid waist fracture; Volar; Percutaneous; Cannulated screw

MeSH Terms

Arm
Bone Resorption
Congenital Abnormalities
Follow-Up Studies
Hand
Hand Strength
Humans
Male
Range of Motion, Articular
Sclerosis
Shoulder
Wrist

Figure

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  Fig. 1 Subacute scaphoid waist fracture with minimal sclerosis. (A) Anteroposterior radiograph shows a minimal sclerotic line around the fracture. (B) Lateral intrascaphoid angle is 28 degrees in CT. (C) Healing was achieved 10 weeks after volar percutaenous screw insertion.

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  Fig. 2 Subacute scaphoid waist fracture with cyst formation. (A) Anteroposterior radiograph shows cyst formation with bone resorption at the fracture. (B) CT shows cyst formation with bone resorption at the waist of scaphoid. (C) Healing was achieved 14 weeks after volar percutaenous screw insertion.

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