Comparison of Dorsal and Volar Percutaneous Approaches in Acute Scaphoid Fractures: A Meta-Analysis.
The dorsal approach allows better central screw placement along the long axis of the scaphoid compared with the volar approach in managing acute scaphoid fractures. However, it is unclear whether the dorsal approach leads to better clinical outcomes than the volar approach. This meta-analysis compared clinical outcomes, including the incidence of nonunion, postoperative complications, overall functional outcome, postoperative pain, grip strength, and range of wrist motion, between the dorsal and volar percutaneous approaches for the management of acute scaphoid fractures. Seven studies met the criteria for inclusion in the meta-analysis. The proportion of patients who developed nonunion (OR 0.74, 95% CI: 0.21 to 2.54; P = 0.63) and postoperative complications (OR 1.05, 95% CI: 0.45 to 2.44; P = 0.91) did not differ significantly between the dorsal and volar approaches. Both approaches also led to similar results in terms of overall functional outcome (95% CI: -0.39 to 0.22; P = 0.57), postoperative pain (95% CI: -0.52 to 0.46; P = 0.92), grip strength (95% CI: -4.56 to 1.02; P = 0.21), flexion (95% CI: -2.86 to 1.13; P = 0.40), extension (95% CI: -1.17 to 2.67; P = 0.44), and radial deviation (95% CI: -1.94 to 2.58; P = 0.78). However, ulnar deviation (95% CI: -7.48 to 0.05; P = 0.05) was significantly greater with the volar approach. Thus, orthopedic surgeons need to master both the dorsal and volar percutaneous approaches because not all acute scaphoid fractures can be dealt with completely with one approach.
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
Kyu-Bok
KB
Kang
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Hyun-Jung
HJ
Kim
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
Jae-Hong
JH
Park
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
Young-Soo
YS
Shin
D000208:Acute Disease; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011884:Radius / Q000503:physiopathology; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D014457:Ulna / Q000503:physiopathology; D014955:Wrist Joint / Q000503:physiopathology