Internal fixation of acute scaphoid proximal pole & waist fractures using the dorsal mini open technique without bone grafting

Abstract

The navicular bone of the hand is the most frequently fractured bone among the carpal bones, and if not treated well, it may result in nonunion. Dorsal, volar open, or percutaneous approaches can be used in surgical treatment. We aimed to evaluate the results of internal fixation of scaphoid fractures with the dorsal mini-open technique. Patients with acute proximal and waist fractures who have been treated with cannulated compression screws with a dorsal mini open approach without grafting between 2015 and 2020 were included. Functional outcomes were analyzed with the DASH questionnaire and MAYO wrist performance scores and compared with the contralateral wrists. The mean age of the patients was 35.6 ±10.8 years (range 20-55), seven were proximal, and 13 were waist fractures. The mean time to surgery was 16±7.3 days (range 5-30) and the mean follow-up time was 47.5±20.2 weeks (range 20-84). The mean DASH score at the last follow-up was 5.9±3.3 points (range 2.5-11.7), and the Mayo wrist performance score was 96.8±5.2 points (range 85-100). In one proximal pole fracture, cracking occurred on the cartilage surface at the screw insertion site but consolidated without any additional intervention. The mean time to union was 8.5±1.2 weeks (range 7-11). Waist region fractures consolidated faster than proximal pole fractures (p=0.002). No significant difference was found between the fracture site and mid-term functional results. Complications like proximal cartilage fractures during the embedding of the screw head or prominence of the screw head can be avoided with the dorsal mini-open technique which is a safe and effective method.