Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches.
OBJECTIVE
To evaluate the position of the screws and find the difference of clinical and radiologic outcome between the volar approach and the dorsal approach groups in percutaneous screw fixation for acute scaphoid fractures.


METHODS
Forty-one consecutive patients with an acute scaphoid fracture, who had percutaneous fixation via either the volar approach or the dorsal approach, were evaluated at an average of 30 months after the surgery. The volar approach was used in 19 patients and the dorsal approach in 22 patients. By using a computerized digital image program, angles between the Herbert screw with respect to the long axis of the scaphoid and the fracture line were measured with plain radiographs in the posteroanterior, lateral, and the 45 degrees semipronated oblique views.


RESULTS
The screws showed no significant difference between the 2 groups in posteroanterior and lateral views; however, screws in the dorsal approach group were observed to be placed more parallel to the long axis of the scaphoid in the semipronated oblique view. The screws in the dorsal approach group were positioned more perpendicular to the fracture lines of the scaphoid compared with those of the volar approach group for all 3 different radiographic views. There was no statistically significant difference between the 2 treatment groups regarding fracture healing. According to the Mayo wrist score system, excellent results were recorded in 18 patients in the dorsal approach group and 15 patients in the volar approach group.


CONCLUSIONS
This study suggests that screws are placed more parallel to the long axis of the scaphoid and perpendicular to the fracture line via the dorsal approach; however, there was no significant difference with regard to functional outcome and bone union.


METHODS
Therapeutic IV.
Jeon
In-Ho
IH
Department of Orthopedic Surgery, College of Medicine, Kyungpook National University Hospital, Chung-Gu, Daegu, Korea. jeonchoi@chollian.net
Micic
Ivan D
ID
Oh
Chang-Wug
CW
Park
Byung-Chul
BC
Kim
Poong-Taek
PT
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D018737:Hand Strength; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*