A comparison of 2 methods for scaphoid central screw placement from a volar approach.

PURPOSE: We studied 2 methods used for screw placement through a volar approach for fixation of scaphoid fractures.

METHODS

We performed measurements on 20 computed tomography scans of unfractured scaphoids. A central virtual guidewire was computed in 10 scaphoids with the wrist in neutral or in extension and ulnar deviation. Second, we compared the central guidewire and a guidewire representing a volar approach to the scaphoid avoiding the trapezium.

RESULTS

The central guidewire passed through the trapezium in all cases with the wrist either in neutral or in extension and ulnar deviation. There was a statistically significant difference only in the sagittal plane. When the central guidewire was compared with a guidewire placed through a standard volar approach, the latter was more eccentric in the distal and waist portions.

CONCLUSIONS

We showed that central placement throughout the scaphoid with a standard volar approach is not feasible without partially resecting, manipulating, or drilling through the trapezium.

CLINICAL RELEVANCE: Our data suggest that a volar transtrapezial approach can be an alternative for optimum central placement in volar percutaneous fixation of scaphoid fractures.