PURPOSE: We studied 2 methods used for screw placement through a volar approach for fixation of scaphoid fractures. METHODS: We performed measurements on 20 computed tomography scans of unfractured scaphoids. A central virtual guidewire was computed in 10 scaphoids with the wrist in neutral or in extension and ulnar deviation. Second, we compared the central guidewire and a guidewire representing a volar approach to the scaphoid avoiding the trapezium. RESULTS: The central guidewire passed through the trapezium in all cases with the wrist either in neutral or in extension and ulnar deviation. There was a statistically significant difference only in the sagittal plane. When the central guidewire was compared with a guidewire placed through a standard volar approach, the latter was more eccentric in the distal and waist portions. CONCLUSIONS: We showed that central placement throughout the scaphoid with a standard volar approach is not feasible without partially resecting, manipulating, or drilling through the trapezium. CLINICAL RELEVANCE: Our data suggest that a volar transtrapezial approach can be an alternative for optimum central placement in volar percutaneous fixation of scaphoid fractures.
PURPOSE: We studied 2 methods used for screw placement through a volar approach for fixation of scaphoid fractures. METHODS: We performed measurements on 20 computed tomography scans of unfractured scaphoids. A central virtual guidewire was computed in 10 scaphoids with the wrist in neutral or in extension and ulnar deviation. Second, we compared the central guidewire and a guidewire representing a volar approach to the scaphoid avoiding the trapezium. RESULTS: The central guidewire passed through the trapezium in all cases with the wrist either in neutral or in extension and ulnar deviation. There was a statistically significant difference only in the sagittal plane. When the central guidewire was compared with a guidewire placed through a standard volar approach, the latter was more eccentric in the distal and waist portions. CONCLUSIONS: We showed that central placement throughout the scaphoid with a standard volar approach is not feasible without partially resecting, manipulating, or drilling through the trapezium. CLINICAL RELEVANCE: Our data suggest that a volar transtrapezial approach can be an alternative for optimum central placement in volar percutaneous fixation of scaphoid fractures.
Authors: Dominik Gruszka; Robert Herr; Hans Hely; Peer Hofmann; Daniela Klitscher; Alexander Hofmann; Pol Maria Rommens Journal: PLoS One Date: 2016-01-07 Impact factor: 3.240