The Treatment of Scaphiod Fractures with Percutaneous Fixation through Palmar Approach

Abstract：Objective To evaluate the clinical outcomes of scaphoid fracture fixation with double-thread screw via volar percutaneous approach. Methods We retrospectively evaluated 17 wrists of 17 patients(16 males,1 female;mean age 25 years,range 17 ~ 44)who underwent volar percutaneous fixation with double-thread screw for acute scaphoid fractures between 2010 and 2014. The left side was involved in 8 cases and the right in 9. Fractures were assessed by X-ray and CT scan and separated into B1(2 cases)and B2(15 cases)according to Herbert. Types of trauma were sports injury(7,41% ),accidental falls(6,35% )and road accident(4 cases,24% ). All patients were operated within 3 ~ 12 days of injury with an average of 6 days. All patients were assessed according to Mayo wrist score postoperatively. X-ray check-ups were made 4,6 and 12weeks after surgery. Fractures were considered as consolidated when X-ray check-ups showed the significant presence of trabeculation crossing the fracture,without pain. Results Mean operative time were 27(range:20 ~ 35)minutes. There was no tendon or vascular nerve damage in any of the patients during surgery. 16 patients'follow-up duration was 13. 5(range:6 ~ 20)months. All the patients healed with an average bone union time of 8. 5(range,8 ~ 13)weeks postoperatively. Results using the Mayo wrist score showed a mean score of 95. 31(range 75 ~ 100). In particular,12 fractures(75% )got excellent results(score 90~ 100),three(18. 75% )good(80 ~ 89)and one(6. 25% )fare(65 ~ 79). The small volar incision of all patients were healed by the first intention. No cases of infection,necrosis or hypertrophic scarring were found during follow-up. Conclusion Percutaneous fixation with double-thread screw via volar approach is a valuable treatment method for scaphoid fractures with the advantages of mini-invasion strong compress at fracture site,high bone union rate and the wrist function recoverd well.