Modified Volar Percutaneous Screw Fixation for the Scaphoid Fractures: Trans-trapezial Approach

Kang, Soo Hwan; Kim, Hyoung Min; Jeong, Changhoon; Lee, Jae Young; Lee, Sang Uk; Park, Il Jung

Abstract

PURPOSE
The purpose of this study is to evaluate the clinical results of modified volar percutaneous fixation, in which a screw is introduced through the trapezium (trans-trapezial approach) for the treatment of undisplaced scaphoid fractures and nonunions.
MATERIALS AND METHODS
We performed modified volar percutaneous screw fixation in 15 patients between December 2008 and October 2009. There were ten men and five women. The mean age was 45 years (range, 20-59 years). Seven patients had a isolated scaphoid fracture, four had a concomitant distal radius fracture, two had multiple fractures besides scaphoid fracture, one had a trans-scaphoid perilunar fracture-dislocation and one had a cystic nonunion of the scaphoid. The mean follow-up time was 13 months. A standard Acutrak headless screw (Acumed(R)) was used in all cases.
RESULTS
At the final follow-up, the average arc of wrist motion was 60degrees of flexion and 65degrees of extension. The average grip power of the affected hand reached 90% compared with the unaffected side. The clinical results assessed by the modified Mayo wrist score showed twelve excellent and three good results. Plain radiographs showed accurate central placement of the screw without degenerative change in the scaphotrapezial joint in all patients. The mean time to union was 7.8 weeks.
CONCLUSION
We believe that the modified volar percutaneous screw fixation is reliable method. However, long term follow-up is required to determine whether this approach would increase the risk of scaphotrapezial joint osteoarthritis.