Purpose
With advances in tools and techniques, percutaneous screw fixation of nondisplaced
fractures of the scaphoid waist has gained increasing popularity in recent years as
an alternative to prolonged cast immobilization or open reduction and internal fixation.
Many reports cite low complication rates, including no complications in some series.
The purpose of this study was to evaluate the complications encountered with dorsal
percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures.
Methods
A retrospective chart review was performed for 24 patients who had surgery performed
by a single surgeon over a 5-year period. All cases involved dorsal percutaneous cannulated
screw fixation of nondisplaced (<1 mm) fractures of the scaphoid waist. Complications
were rated a priori as major or minor based on modifications of established criteria.
Results
The overall complication rate was 29%; there were 21% (5/24) major complications and
8% (2/24) minor complications. Major complications consisted of 1 case of nonunion,
3 cases involving hardware problems, and 1 case of postoperative fracture of the proximal
pole of the scaphoid. Minor complications included intraoperative equipment breakage—1
case involving a screw and 1 case involving a guide wire.
Conclusions
Complications in dorsal percutaneous cannulated screw fixation of scaphoid fractures
may be more common than previously reported.
Type of study/level of evidence
Therapeutic IV.
Key words
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References
- Percutaneous screw fixation for fractures of the scaphoid.J Bone Joint Surg. 1991; 73B: 138-142
- Acute percutaneous scaphoid fixation: a pilot study.J Bone Joint Surg. 1998; 80B: 95-99
- Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.J Hand Surg. 2001; 26B: 192-195
- Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures.J Bone Joint Surg. 2001; 83A: 483-488
- Fracture of the carpal scaphoid.J Bone Joint Surg. 2001; 83B: 230-234
- Arthroscopic reduction and percutaneous fixation of scaphoid fractures with a novel dorsal technique.Orthop Clin North Am. 2001; 32: 247-261
- Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach.J Bone Joint Surg. 2002; 84A: 21-36
- Percutaneous cannulated screw fixation of acute scaphoid waist fracture.J Hand Surg. 2002; 27B: 42-46
- Minimal invasive percutaneous Herbert screw fixation in acute unstable scaphoid fracture.Hand Surg. 2003; 8: 213-218
- Percutaneous screw fixation for unstable scaphoid fractures.J Trauma. 2005; 59: 184-187
- Should acute scaphoid fractures be fixed?.J Bone Joint Surg. 2005; 87A: 2160-2168
- Percutaneous osteosynthesis versus cast immobilisation for the treatment of minimally and non-displaced scaphoid fractures.Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005; 149: 149-151
- A technical note on percutaneous scaphoid fixation using a hybrid technique.J Orthop Trauma. 2005; 19: 570-573
- Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures.Arthroscopy. 2005; 21: 620-626
- Combined fractures of the scaphoid and distal radius: a revised treatment rationale using percutaneous and arthroscopic techniques.Hand Clin. 2005; 21: 427-441
- Carpal ligament injuries with acute scaphoid fractures—a combined wrist injury.J Hand Surg. 2005; 30B: 415-418
- Fixation of nondisplaced scaphoid fractures: making treatment cost effective: prospective controlled trial.Arch Orthop Trauma Surg. 2007; 127: 39-46
- Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach: an assessment of radiographic and functional outcomes.J Hand Surg. 2007; 32A: 326-333
- Taking it back: surgeons retract podium statements to reflect new practices.Orthopedics Today. 2007; 27: 90
- Percutaneous fixation of scaphoid fractures.Hand Clin. 2001; 17: 553-574
- Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach.J Bone Joint Surg. 2003; 85A: 20-32
- Complications of wrist arthroscopy.J Hand Surg. 2004; 29A: 406-411
- X-ray diagnosis of acute scaphoid fractures.J Hand Surg. 2006; 31B: 104-109
- Percutaneous screwing of the navicular bone of the hand with a compression drill screw (a new method).Zentralbl Chir. 1970; 95: 1060-1078
- Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques.J Hand Surg. 2004; 29A: 74-79
- Percutaneous Herbert screw osteosynthesis of the scaphoid bone.Acta Orthop Belg. 1995; 61: 43-47
- Acute percutaneous scaphoid fixation using a cannulated screw.Chir Main. 1998; 17: 119-126
Article info
Publication history
Accepted:
April 11,
2007
Received:
December 5,
2006
Footnotes
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
The authors would like to thank Laura McCoy, Jean Godwin, and Cathy Wells for their assistance with this research project.
Identification
Copyright
© 2007 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.