title: Optimization of volar percutaneous screw fixation for scaphoid waist fractures using traction, positioning, imaging, and an angiocatheter guide.
abstract: Percutaneous screw fixation of nondisplaced or reducible scaphoid fractures has become more popular as techniques and implants have improved. Many authors have advocated for the dorsal approach, citing difficulties with adequate screw placement from the volar approach. We have developed a straightforward and reproducible technique for volar percutaneous scaphoid screw fixation that mitigates most of the drawbacks of the approach. The wrist is held in extension and ulnar deviation with traction through the thumb. A 14-gauge angiocatheter needle is then used to localize the starting point and as a cannula for the guide wire. Specific fluoroscopic views help to confirm optimal guide wire placement.
authors.affiliation: Department of Orthopaedics, Shriners Hospital for Children, Philadelphia, PA 19140, USA. dzlotolow@yahoo.com
authors.forename: Dan A
authors.initials: DA
authors.lastname: Zlotolow
authors.forename: Elisa
authors.initials: E
authors.lastname: Knutsen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Yao
mesh_terms: D001863:Bone Screws; D057785:Catheters; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D056888:Patient Positioning; D020127:Recovery of Function / Q000502:physiology; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery*; D016683:Supine Position; D014143:Traction / Q000379:methods; D016896:Treatment Outcome