Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches.

PURPOSE: 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.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.