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. 2017 Jul;12(4):362-368.
doi: 10.1177/1558944716681948. Epub 2016 Nov 28.

Percutaneous Treatment of Unstable Scaphoid Waist Fractures

Andrew P Matson  1 , Ryan M Garcia  1   2 , Marc J Richard  1 , Fraser J Leversedge  1 , J Mack Aldridge  3 , David S Ruch  1
Affiliations

Percutaneous Treatment of Unstable Scaphoid Waist Fractures

Andrew P Matson et al. Hand (N Y). 2017 Jul.

Abstract

Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoid fractures, although less information has been reported about outcomes for unstable, displaced fractures. The aim of this study was to evaluate the union and complication rates following manual closed reduction and percutaneous screw placement for a consecutive series of unstable, displaced scaphoid fractures.

Methods: A total of 28 patients (average age, 27 years; 22 male/6 female) were treated for isolated unstable displaced scaphoid waist fractures. Closed reduction and percutaneous headless, compression screw fixation was successfully performed in 14 patients (average age, 32 years; 10 male/4 female), and the remaining 14 patients required open reduction. Patients who underwent percutaneous treatment were followed for radiographic fracture union and clinical outcomes.

Results: Thirteen of 14 fractures (93%) had clinical and radiographic evidence of bone union at an average of 2.8 months postoperatively. Average visual analog pain score at the time of union was 0.9. The average Quick Disability of the Arm, Shoulder, and Hand score at 2.5 years follow-up (range, 1.5-8.3 years) was 9.6 (range, 0.0-27.3). Complications included 1 case of nonunion and 1 case of intraoperative Kirschner wire breakage.

Conclusions: Manual closed reduction followed by percutaneous headless, compression screw fixation was possible in 50% of patients who presented with acute unstable, displaced scaphoid fractures. This technique appears to be a safe and effective method when a manual reduction is possible, and it may offer a less invasive option when compared with a standard open technique.

Keywords: fracture; navicular; percutaneous; scaphoid; unstable.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.J.R. is a consultant for Acumed. F.J.L. receives royalties from Orthohelix Surgical Designs/Tornier. J.M.A. has received speaker honorarium from Acumed.

Figures

Figure 1.
Figure 1.
(a) Intraoperative fluoroscopy posteroanterior images showing use of a pointed tenaculum reduction clamp and guidewires to temporarily hold scaphoid reduction via the percutaneous approach, and (b) subsequent application of two cannulated, headless compression screws in the volar to dorsal direction.
Figure 2.
Figure 2.
(a-b) Posteroanterior and lateral radiographs of a 20-year-old man who sustained a displaced fracture of the scaphoid waist and (c-d) radiographs obtained 2 months postoperatively following closed reduction and percutaneous fixation of the scaphoid with a single screw in the dorsal to volar direction, confirming radiographic union.
Figure 3.
Figure 3.
Coronal computed tomography image obtained to confirm reduction in a 26-year-old female 2.5 months postoperatively following closed reduction and percutaneous screw fixation in the volar to dorsal direction for a scaphoid waist fracture. Note. Bridging trabeculation is present throughout most of the fracture site.
See this image and copyright information in PMC

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