Transtrapezial Approach for Fixation of Acute Scaphoid Fractures.

Abstract

The transtrapezial approach for fixation of acute scaphoid fractures facilitates precise percutaneous placement of a screw along the central axis of the scaphoid, which has been shown to be biomechanically superior. Correctly position the patient, surgeon, and fluoroscopy equipment before starting the procedure. Mark the central axis of the scaphoid on the skin along the anteroposterior and lateral (optional) planes as the markings allow visual control for insertion of the guidewire. Make a volar stab incision over the distal half of the trapezium. Insert the guidewire through the trapezium along the central axis of the scaphoid, which is the critical step of the procedure. Drill the trapezium and the distal cortex of the scaphoid to allow easy insertion of the screw. Precisely measure the scaphoid length to determine the appropriate screw length. Insert the selected screw over the guidewire. In our report on the first results of this technique in forty-one patients with an acute nondisplaced scaphoid waist fracture, all fractures united within ten weeks (mean, 6.4 weeks) and the modified Mayo wrist score was good (four patients) or excellent (thirty-seven patients) at a mean follow-up of thirty-six months (range, fourteen to sixty-eight months).IndicationsContraindicationsPitfalls & Challenges.