Abstract
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.
Highlights
The scaphoid is the most commonly fractured carpal bone, accounting for over 60% of carpal fractures and 11% of all hand fractures in young and active individuals.[1]
After removing 2015 duplicates, 1825 studies remained; of these, 1810 were excluded based on reading the abstracts and full-text articles, and an additional 8 studies were excluded because they had unusable information, measured only one of the six parameters, or made inappropriate group comparisons
The 7 studies we examined included patients who underwent surgical treatment of acute scaphoid fractures through the dorsal percutaneous approach and patients who underwent surgical treatment of acute scaphoid fractures through the volar percutaneous approach
Summary
The scaphoid is the most commonly fractured carpal bone, accounting for over 60% of carpal fractures and 11% of all hand fractures in young and active individuals.[1]. Dorsal and Volar Percutaneous Approaches in Acute Scaphoid Fractures fixation for the treatment of fractures that have traditionally been treated conservatively can lead to early functional recovery by better fixation and more rapid bone union.[3,4,5] open reduction and internal fixation increase the risk of complications associated with damage to important structures, leading to carpal instability and tenuous vascular supply.[3,6] percutaneous screw fixation has increased in popularity with the use of new headless compression screws and better surgical techniques, for which the benefits offset the risks.[5] More recent studies comparing the dorsal and volar approaches have found better biomechanical and clinical outcomes.[7,8,9,10] most orthopedic surgeons have shifted from open reduction and internal fixation to percutaneous screw fixation through the dorsal or volar approach. Central screw position can be more reliably achieved using a dorsal approach, it is unclear whether these biomechanical advantages are accompanied by clinical advantages.[9,11,12,13] In addition, no systematic reviews or metaanalyses have been published on this subject
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