Percutaneous Scaphoid Fixation with Herbert Screw; Comparison of Dorsal and Volar Approach

Journal of the Korean Society for Surgery of the Hand 2004;9(4):239-244.
Published online December 1, 2004.

In-Ho Jeon, Chang-Wug Oh, Kyu-Bong Lee, Il-Hyung Park, Poong-Taek Kim

Herbert 나사못을 이용한 경피적 주상골 고정 ; 수장부 도달법과 수배부 도달법의 비교

전인호, 오창욱, 이규봉, 박일형, 김풍택

Abstract

Introduction:Percutaneous scaphoid fixation is a popular procedure in the management of scaphoid fractures. Both volar and dorsal approaches are used currently. We compared and analyzed the clinical and radiographic results between dorsal and volar approaches. Materials and Methods:Forty-one patients with scaphoid fracture underwent percutaneous Herbert screw fixation and were reviewed retrospectively. The average age of the patients was 28 years (range, 14~64years) and all were male except two. Volar approach was used in 19 patients and dorsal in 22. K-wire was used temporarily to fix the fracture and non cannulated Herbert screw was introduced parallel to the K-wire. Patients were followed up for a minimum of 12 months. Axes of the Herbert screw and scaphoid were measured in the computerized digital image program. Results: The Herbert screws were placed more parallel to the long axis of scaphoid (19.59¡Æ:22.63¡Æ) and were positioned more vertical to the fracture line (24.59¡Æ: 16.84¡Æ) in dorsal group compared to volar group . Twenty patients in dorsal group showed excellent results and 16 patients (84%) in volar approach respectively. Average time for fracture healing was 8.5 weeks in dorsal group and 9.2 weeks in volar group. Conclusion:The Herbert screws positioned more parallel along the long axis of scaphoid and vertical to the fracture site when dorsal approach was used. There was no significant difference in the functional outcome and bone union between two groups.