Cadaveric assessment of a new guidewire insertion device for volar percutaneous fixation of nondisplaced scaphoid fracture.

PURPOSE: Volar percutaneous screw fixation (PSF) of acute nondisplaced scaphoid waist fractures allows early mobilisation of the wrist and a faster return to work than prolonged cast immobilisation. Usually, placement of the wire which guides the definitive canulated screw is performed by hand. Nevertheless, correct placement of this wire is technically difficult. We designed a guidewire insertion device (GID) to facilitate this placement.

METHODS

We compared the hand held technique with the technique using the GID in a cadaveric study. The hand held technique was performed on 16 scaphoids and the GID was used in 16 other scaphoids. The four participating surgeons were divided into two groups: two experienced surgeons and two inexperienced surgeons.

RESULTS

The GID significantly decreased procedure duration (P<0.001), number of attempts to place the wire (P<0.001), and number of image-intensifier shots (P<0.001). With both techniques, experienced surgeons were significantly faster (P=0.0083) and required significantly fewer attempts (P=0.043) than inexperienced surgeons. Using the GID, the procedure duration (P=0.0039) and the number of image-intensifier shots (P<0.001) decreased more with inexperienced surgeons than with experienced surgeons. As for the number of attempts, there was no statistical difference between the two groups (P=0.32).

CONCLUSIONS

The GID decreased the time and radiation exposure needed to achieve correct volar percutaneous wire placement in the scaphoid, compared to the conventional hand held technique. Easier wire placement may lead surgeons to use PSF instead of prolonged cast immobilisation for treating nondisplaced scaphoid fractures.