Volar percutaneous transtrapezial fixation of scaphoid waist fractures : surgical technique


Published online: Feb 27 2012

Ghislain F. A. E. GEURTS, Roger P. VAN RIET, Geert MEERMANS, Frederik VERSTREKEN

From the Monica Research (MoRe) Foundation, Monica Hospital Deurne, Antwerp, Belgium and the Lievensberg Hospital, Bergen op Zoom, The Netherlands

Abstract

Percutaneous screw fixation of scaphoid fractures has gained popularity over the years. The disadvantages of a long period of cast immobilisation are avoided and this technique allows a more rapid return to work and sports activities than conservative treatment. Consequently, percutaneous screw fixation is appealing for the young and active population. Biomechanical studies showed that greater fixation strength is obtained when the screw is placed centrally than eccentrically. Central screw placement can however be technically demanding. In the use of a volar percutaneous approach, the trapezium and the shape of the scaphoid impede central screw placement. Different approaches are available to overcome this difficulty. The volar percutaneous transtrapezial approach facilitates and allows more accurate central screw placement compared to approaches that try to avoid the trapezium. The surgical technique of this approach is described.