Percutaneous Scaphoid Fixation: Experience Value among Different Approaches

Abstract

Background Percutaneous scaphoid osteosynthesis is an attractive and increasingly popular option, as a treatment for acute scaphoid fractures in selected cases, and as an alternative to conservative treatment. The purpose of this study is to assess the radiographic positioning of the screw in percutaneous scaphoid fixation, taking into consideration the surgeons' experience, and the difference between volar and dorsal approaches.

Methods We retrospectively assessed patients undergoing percutaneous scaphoid fixation from 2013 to 2019. Inclusion criteria are as follows: (1) scaphoid waist fractures (Herbert's B2), (2) a minimum of 18 years of age and a maximum of 55 years of age, (3) dominant hand, (4) manual work, (5) minimum follow-up time of 6 months, and (6) without associated lesions. Criteria for correct positioning are as follows: (1) on the axis or parallel to the scaphoid axis with a maximum deviation of 1.5 mm volar/dorsal, (2) without proximal/dorsal prominence, (3) correct scaphoid alignment/reduction, and (4) absence of threads in the fracture site. Radiographs were evaluated separately by a hand surgeon, a general orthopaedic surgeon, and an orthopaedic resident.

Results With a total of 39 patients, a dorsal approach was performed in 10 patients and a palmar approach in 29 patients. We verified a very good interobserver reliability. The hand surgeon's team correctly positioned 15 (83.3%, 15/18), while the other team did 9 correctly (42.9%, 9/21). Comparing teams according to the approach used, the dorsal approach did not show a statistical difference, while the same was not true for the volar approach (p < 0.05).

Conclusion This points to a positive impact on the team's experience in the positioning of the screws, and therefore in the benefit of treatment by teams dedicated to the area, while daring to suggest that less-experienced surgeons should utilize the dorsal approach.

Keywords

dorsal/volar approach - experience - percutaneous fixation - positioning - scaphoid fracture

Note

Informed consent was not sought for this article because all patient's information remained confidential.

Ethical Approval

Ethical approval for this study was obtained from ethics committee for health from Centro Hospitalar Universitário Lisboa Central, EPE, approval number: 888/2020.

Publikationsverlauf

Eingereicht: 25. Mai 2020

Angenommen: 14. Juli 2020

Artikel online veröffentlicht:
10. September 2020

• References

• 1 Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J 2016; 98-B [phone]
• 2 Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid fracture epidemiology. J Trauma Acute Care Surg 2012; 72 (02) E41-E45
• 3 Suh N, Benson EC, Faber KJ, Macdermid J, Grewal R. Treatment of acute scaphoid fractures: a systematic review and meta-analysis. Hand (N Y) 2010; 5 (04) 345-353
• 4 Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med 2015; 34 (01) 37-50
• 5 Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am 2015; 40 (09) 1797-1805.e3
• 6 Luria S, Lenart L, Lenart B, Peleg E, Kastelec M. Optimal fixation of oblique scaphoid fractures: a cadaver model. J Hand Surg Am 2012; 37 (07) 1400-1404
• 7 Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am 2004; 29 (01) 74-79
• 8 McCallister WV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am 2003; 85 (01) 72-77
• 9 Leventhal EL, Wolfe SW, Walsh EF, Crisco JJ. A computational approach to the “optimal” screw axis location and orientation in the scaphoid bone. J Hand Surg Am 2009; 34 (04) 677-684
• 10 Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol 2016; 41 (04) 365-366
• 11 Jeon IH, Micic ID, Oh CW, Park BC, Kim PT. Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches. J Hand Surg Am 2009; 34 (02) 228-36.e1
• 12 Kang KB, Kim HJ, Park JH, Shin YS. Comparison of dorsal and volar percutaneous approaches in acute scaphoid fractures: a meta-analysis. PLoS One 2016; 11 (09) e0162779
• 13 Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV. Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am 2000; 82 (05) 633-641
• 14 Dodds SD, Panjabi MM, Slade III JF. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 2006; 31 (03) 405-413
• 15 Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996; 78 (12) 1829-1837
• 16 Ten Berg PWL, Dobbe JGG, Brinkhorst ME. et al. Scaphoid screw fixation perpendicular to the fracture plane: comparing volar and dorsal approaches. Orthop Traumatol Surg Res 2018; 104 (01) 109-113
• 17 Slade III JF, Grauer JN, Mahoney JD. Arthroscopic reduction and percutaneous fixation of scaphoid fractures with a novel dorsal technique. Orthop Clin North Am 2001; 32 (02) 247-261
• 18 Meermans G, Van Glabbeek F, Braem MJ, van Riet RP, Hubens G, Verstreken F. Comparison of two percutaneous volar approaches for screw fixation of scaphoid waist fractures: radiographic and biomechanical study of an osteotomy-simulated model. J Bone Joint Surg Am 2014; 96 (16) 1369-1376
• 19 Saedén B, Törnkvist H, Ponzer S, Höglund M. Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment. J Bone Joint Surg Br 2001; 83 (02) 230-234
• 20 Adamany DC, Mikola EA, Fraser BJ. Percutaneous fixation of the scaphoid through a dorsal approach: an anatomic study. J Hand Surg Am 2008; 33 (03) 327-331
• 21 Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 2018; 33 (10) 3329-3342
• 22 Zhou C, Ceyisakar IE, Hovius SER. et al. Surgeon volume and the outcomes of dupuytren's surgery: results from a dutch multicenter study. Plast Reconstr Surg 2018; 142 (01) 125-134
• 23 Liverneaux PA, Gherissi A, Stefanelli MB. Kirschner wire placement in scaphoid bones using fluoroscopic navigation: a cadaver study comparing conventional techniques with navigation. Int J Med Robot 2008; 4 (02) 165-173