title: Structures at Risk During Volar Percutaneous Fixation of Scaphoid Fractures: A Cadaver Study.
abstract: BACKGROUND
  Fracture of the scaphoid bone can be treated with cast immobilization or surgery. Historically, surgery was reserved for displaced fractures. However, because weeks of cast immobilization may result in stiffness, loss of strength, loss of bone density and an inability to work or participate in recreational activities for a prolonged period, operative treatment of non-displaced fractures has become increasingly common. Several surgical techniques for fixation have been described, but their risks and benefits have not yet been clearly elucidated. In a study in cadavers, we investigated whether one approach--volar percutaneous fixation--might pose a risk of injury to surrounding structures.
  
  
  METHODS
  In 15 cadaver upper limbs with the wrist structures intact, a K-wire was inserted in a volar percutaneous manner under fluoroscopic guidance, distal to proximal and through the scaphoid waist into the center-center position. The volar aspect of the wrist and hand were then dissected around the K-wire, with isolation of surrounding structures. The distance between the K-wire and several individual structures was then measured with use of a digital caliper.
  
  
  RESULTS
  The K-wire was at least 4 mm from the superficial radial nerve, the first dorsal extensor compartment, the recurrent motor branch of the median nerve, and the radial artery (RA) in all specimens. However, the K-wire had penetrated die flexor carpi radialis (FCR) tendon in four specimens and was directly adjacent to it in another four. In one specimen, the K-wire was directly adjacent to the superficial volar branch of die RA.
  
  
  CONCLUSIONS
  The K-wire may penetrate the FCR tendon and the superficial volar branch of the radial artery during volar percutaneous scaphoid fixation. The possible long-term clinical implications of this finding require investigation.
  
  
  CONCLUSIONS
  Our findings indicate that modification of the volar percutaneous approach to scaphoid fixation may be advisable to avoid damage to adjacent structures. We suggest use of a "mini-open" percutaneous procedure.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center , Albuquerque , New Mexico.
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center , Albuquerque , New Mexico ; Center for Biomedical Engineering, University of New Mexico , Albuquerque , New Mexico.
authors.forename: Justin
authors.initials: J
authors.lastname: Brantley
authors.affiliation: School of Medicine, University of New Mexico , Albuquerque , New Mexico.
authors.forename: Christina
authors.initials: C
authors.lastname: Brady
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center , Albuquerque , New Mexico ; Center for Biomedical Engineering, University of New Mexico , Albuquerque , New Mexico.
authors.forename: Christina
authors.initials: C
authors.lastname: Salas
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center , Albuquerque , New Mexico.
authors.forename: Deana
authors.initials: D
authors.lastname: Mercer
mesh_terms: D000328:Adult; D001863:Bone Screws; D001864:Bone Wires; D002102:Cadaver; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012680:Sensitivity and Specificity; D016683:Supine Position