Acute scaphoid fractures treated by cannnlated compression screw fixation through a limited palmar approach

Abstract

Objective To discuss the indication, surgical techniques, and results of cannulated compression screw fixation through a limited palmar approach for treatment of acute seaphoid fractures. Methods From 2003 to 2007, 16 patients with acute scaphoid fracture were treated by the above technique. All the fractures belonged to the Herbert A2 and Herbert B2 types, two of which were complicated with distal radial fracture. A longitudinal skin incision, approximately 2em in length, was made at the palmer-radial side of the wrist, with the scaphoid tubercle located in the middle of the incision. After removal of palmar articular surface of the trapezium base, an appropriate length of AO cannulated compression screw was driven into the scaphoid along its axis under supervision of a mini C-arm image intensifier and direction of a guide wire. Immobilization was unnecessary after operation. Results We were able to follow up only 12 cases of them. The mean follow up was 18 (6 to 55) months. The mean radiological time of bone union was 42 days after op-eration. The mean time of resuming work was 10 (3 to 28) days. Ten of them obtained the same range of wrist motion as the contralateral side. Two patients lost an average radial deviation and palmar flexion of 5°. All pa-tients experienced no pain except two who reported only mild pain at palmar flexion. No early complication was encountered. Conclusion Cannulated compression screw fixation through a limited palmar approach is fine for acute scaphoid fractures, because it is easy, leads to minimal lesion to soft tissue, allows immediate mobilization without prolonged casting, and promises a high union rate. Key words: Scaphoid; Fracture; Wrist; Surgical procedures, minimally invasive