Download PDF
J Wrist Surg 2020; 09(01): 034-038
DOI: 10.1055/s-0039-1698745
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Ludovico Lucenti 
1   Department of Orthopaedic Surgery, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Italy
,
Kevin F. Lutsky
2   Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
3   Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
,
Christopher Jones
2   Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
3   Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
,
Erick Kazarian
4   Massachusetts General Hospital, Boston, Massachusetts
,
Daniel Fletcher
2   Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
3   Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
,
Pedro K. Beredjiklian 
2   Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
3   Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

27 March 2019

05 September 2019

Publication Date:
16 October 2019 (online)

    Permissions and Reprints

Abstract

Background Scaphoid waist fractures are often treated using headless compression screws using dorsal or volar approaches.

Objectives The purpose of this study is to compare differences in screw position using a volar (retrograde) or dorsal (antegrade) approach.

Patients and Methods A total of 82 patients were retrospectively evaluated: 41 treated with a volar and 41 with a dorsal approach were selected. Postoperative radiographs were reviewed by three observers who rated screw location in the proximal pole, waist, and distal pole.

Results Thirty-four patients (83%) in the antegrade group had central screw placement in the waist of the scaphoid in posteroanterior and lateral planes compared with 14 (34.9%) in the retrograde group (p < 0.05). For the antegrade group, the screw was central in 217 of 246 zones (88.2%) compared with 127 of 246 (51.6%) in the retrograde group (p < 0.05).

Conclusions The dorsal antegrade approach appears to allow the surgeon to achieve central screw placement along all three scaphoid regions.

Level of Evidence This is Level III study.

Keywords

antegrade approach - retrograde approach - scaphoid screw fixation - scaphoid waist fracture

Note

The work was performed at The Rothman Institute of Philadelphia.


 

  • References

  • 1 Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J 2016; 98-B (05) 654-659
    CrossrefPubMedSearch in Google Scholar
  • 2 Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med 2015; 34 (01) 37-50
    CrossrefPubMedSearch in Google Scholar
  • 3 Luria S, Lenart L, Lenart B, Peleg E, Kastelec M. Optimal fixation of oblique scaphoid fractures: a cadaver model. J Hand Surg Am 2012; 37 (07) 1400-1404
    CrossrefPubMedSearch in Google Scholar
  • 4 Bedi A, Jebson PJ, Hayden RJ, Jacobson JA, Martus JE. Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach: an assessment of radiographic and functional outcomes. J Hand Surg Am 2007; 32 (03) 326-333
    CrossrefPubMedSearch in Google Scholar
  • 5 Dodds SD, Panjabi MM, Slade III JF. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 2006; 31 (03) 405-413
    CrossrefPubMedSearch in Google Scholar
  • 6 Al-Ashhab ME, Elbegawi HEA. Percutaneous screw fixation for scaphoid fractures. Orthopedics 2017; 40 (04) e729-e734
    CrossrefPubMedSearch in Google Scholar
  • 7 Kang KB, Kim HJ, Park JH, Shin YS. Comparison of dorsal and volar percutaneous approaches in acute scaphoid fractures: a meta-analysis. PLoS One 2016; 11 (09) e0162779
    CrossrefPubMedSearch in Google Scholar
  • 8 McCallister WV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am 2003; 85 (01) 72-77
    CrossrefPubMedSearch in Google Scholar
  • 9 Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am 2004; 29 (01) 74-79
    CrossrefPubMedSearch in Google Scholar
  • 10 Jeon IH, Micic ID, Oh CW, Park BC, Kim PT. Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches. J Hand Surg Am 2009; 34 (02) 228-36.e1
    CrossrefPubMedSearch in Google Scholar
  • 11 Meermans G, Van Glabbeek F, Braem MJ, van Riet RP, Hubens G, Verstreken F. Comparison of two percutaneous volar approaches for screw fixation of scaphoid waist fractures: radiographic and biomechanical study of an osteotomy-simulated model. J Bone Joint Surg Am 2014; 96 (16) 1369-1376
    CrossrefPubMedSearch in Google Scholar
  • 12 Zlotolow DA, Knutsen E, Yao J. Optimization of volar percutaneous screw fixation for scaphoid waist fractures using traction, positioning, imaging, and an angiocatheter guide. J Hand Surg Am 2011; 36 (05) 916-921
    CrossrefPubMedSearch in Google Scholar
  • 13 Acar B, Kose O, Kati YA, Egerci OF, Turan A, Yuksel HY. Comparison of volar versus dorsal screw fixation for scaphoid waist fractures: A finite element analysis. Orthop Traumatol Surg Res 2018; 104 (07) 1107-1113
    CrossrefPubMedSearch in Google Scholar
  • 14 Swanstrom MM, Morse KW, Lipman JD, Hearns KA, Carlson MG. Effect of screw perpendicularity on compression in scaphoid waist fractures. J Wrist Surg 2017; 6 (03) 178-182
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Kupperman A, Breighner R, Saltzman E, Sneag D, Wolfe S, Lee S. Ideal starting point and trajectory of a screw for the dorsal approach to scaphoid fractures. J Hand Surg Am 2018; 43 (11) 993-999
    CrossrefPubMedSearch in Google Scholar