title: Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach: an assessment of radiographic and functional outcomes.
abstract: OBJECTIVE
  To evaluate the clinical and radiographic outcomes of a consecutive series of patients who had internal fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach.
  
  
  METHODS
  Twenty consecutive patients had surgical fixation of a nondisplaced scaphoid waist (Herbert B2) fracture via a limited dorsal approach. Eighteen patients were available for follow-up evaluation at a mean duration of 98 weeks after surgery (range, 12-272 wk). Fifteen males and 3 females with a mean age of 25 years (range, 16-62 y) were examined. Wrist range of motion; grip strength; visual analog and numeric pain scores; and a Disabilities of the Arm, Shoulder, and Hand (DASH) outcomes questionnaire were assessed. Postoperative radiographs were reviewed in a blinded fashion to assess the fracture union and screw position.
  
  
  RESULTS
  Seventeen of 18 fractures healed at a mean duration of 8 weeks. No case of proximal pole avascular necrosis occurred. All patients were satisfied and returned to their pre-injury level of employment. Five of 6 collegiate or professional athletes returned to play without limitations. The mean subjective and visual analog pain scores were 0.3 and 0.4 (maximum of 10 for each scale). The mean DASH score was 6.12 (out of 100), which is consistent with an excellent functional outcome. Central axis screw position was achieved on anteroposterior and lateral radiographs in 17 of 18 patients.
  
  
  CONCLUSIONS
  Fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach is safe and effective. The limited dorsal approach allows for accurate insertion of the screw in the central scaphoid, which is biomechanically advantageous for fracture union and early restoration of function.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Division of Elbow, Hand, and Microvascular Surgery, Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI 48105, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.forename: Peter J L
authors.initials: PJ
authors.lastname: Jebson
authors.forename: Radford J
authors.initials: RJ
authors.lastname: Hayden
authors.forename: Jon A
authors.initials: JA
authors.lastname: Jacobson
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Martus
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*