Volar percutaneous Bold screw fixation of scaphoid fractures using a syringe needle guide

Abstract

Objective To evaluate the clinical outcomes of scaphoid fracture fixation with a 3.0 mm Bold cannulated screw via volar percutaneous approach guided by a 50 ml syringe needle.Methods Twentyfour patients with scaphoid fractures surgically treated between July 2006 and March 2011 were enrolled in this study.According to Herbert's classification,there were 3 type A2,2 type B1,11 type B2,5 type C and 3 type D1 fractures.Under C-arm fluoroscopy monitoring,a 50 ml syringe needle was placed into the distal pole of the scaphoid via the scaphotrapezial joint and adjusted to be aligned with the scaphoid axis.Then the guide wire was advanced across the fracture through the syringe needle cannula.The syringe needle was withdrawn while the depth of the screw was measured.A 3.0 mm Bold cannulated screw was introduced along the guide to hold and compress the two fracture segments.A wrist cast was applied for two weeks after which mobilization exercises were gradually carried out.Results All patients were follow-up for a mean period of 15 months (range,6 to 24 months).One case of type D1 fracture suffered fracture nonunion and was subsequently cured by reoperation with bone grafting and internal fixation.All the other fractures healed with an average bone union time of 18 weeks (range,8 to 32 weeks).No infection,scar formation,traumatic arthritis or vascular nerve injury occurred during follow-up.The Cooney wrist score averaged 91.4 (range,76 to 100).The functional result was ranked as excellent in 14 patients,good in 8 patients and fair in 2 patients.The excellent and good rate was 91.7％.Conclusion Volar percutaneous Bold cannulated screw fixation is an ideal choice for Herbert type A2,B1,B2 and C scaphoid fractures because it is safe and effective and causes little scar and minimum soft tissue dissection.Utilizing a 50 ml syringe needle as guidance makes the guide wire insertion more easy,accurate and convenient. Key words: Scaphoid; Fractures, bone; Syringe needle; Volar; Percutaneous fixation; Cannulated screw