Comparison of volar and dorsal percutaneous screw fixation in acute scaphoid waist fracture

Abstract

Objective To compare volar and dorsal percutaneous screw fixation in acute scaphoid waist fracture. Methods Retrospectively collected patients received percutaneous screw fixation after acute scaphoid fracture between January 2009 and December 2014 with non-displacement/minimal displacement waist fracture, patients with open fracture or combined with perilunate dislocation or fracture which need reduce were excluded, 28 patients with intact follow-up were enrolled, 26 men and 2 women, with an average age of 31 years old. Based on Herbert classification, there were 15 A2 type, 5 B1 type, 8 B2 type. 7 cases were high energy trauma and 21 were low energy. The patients were divided into 2 groups by volar and dorsal approach. The general condition, surgery notes, radiological evidence and follow-up were collected and analyzed. Results 28 cases with full follow-up were enrolled, 18 cases received surgery via volar approach, and 10 cases via dorsal approach, the mean follow-up period is 33 months. Peri-operative data showed that operation time in dorsal approach group was longer (75 min vs. 54 min). We evaluated screw position by measuring the angulation between screw and fracture line as well as screw and long axis of scaphoid based on AP view and lateral view of wrist X-rays. There was no significant difference in length of screws (21.4 mm vs. 21.8 mm). Patients gradually went back to work after 2 weeks and got fracture healing within 12 weeks after operation. Radiological evidence showed that angulation between screw and long axis of scaphoid was 6.11°±4.82° in AP position and 8.48°±5.77° in lateral position, angulation between screw and fracture line was 73.58°±20.75° in AP position and 70.72°±21.19° in lateral position. There were no significant differences between screw insertion positions between 2 groups. Visual analogue scale (VAS) was used to evaluate wrist pain in the follow-up, Mayo wrist score and Patient-Rated Wrist Evaluation (PRWE) were also used to assess wrist function in the follow-up. The clinical results were promising, the excellent or good rate of Mayo wrist score was 100%, there were no significant difference in VAS, Mayo wrist score and PRWE between volar and dorsal approach. No complications such as failure of screws, orthopaedic arthritis or scaphoid necrosis were observed. Conclusion Percutaneous screw fixation have a satisfied effect in the treatment of acute scaphoid waist fracture, and there are no differences in clinical efficacy between volar and dorsal approach. Key words: Scaphoid bone; Fractures, bone; Carpal joints; Fracture fixation, internal