Introduction The transtrapezial approach for fixation of acute scaphoid fractures facilitates precise percutaneous placement of a screw along the central axis of the scaphoid, which has been shown to be biomechanically superior.
Step 1: Position the Patient, Surgeon, and Fluoroscopy Equipment Correctly position the patient, surgeon, and fluoroscopy equipment before starting the procedure.
Step 2: Mark the Skin Mark the central axis of the scaphoid on the skin along the anteroposterior and lateral (optional) planes as the markings allow visual control for insertion of the guidewire.
Step 3: Stab Incision Make a volar stab incision over the distal half of the trapezium.
Step 4: Insert the Guidewire Insert the guidewire through the trapezium along the central axis of the scaphoid, which is the critical step of the procedure.
Step 5: Drilling Drill the trapezium and the distal cortex of the scaphoid to allow easy insertion of the screw.
Step 6: Length Measurement Precisely measure the scaphoid length to determine the appropriate screw length.
Step 7: Insert the Screw Insert the selected screw over the guidewire.
Results In our report on the first results of this technique in forty-one patients with an acute nondisplaced scaphoid waist fracture, all fractures united within ten weeks (mean, 6.4 weeks) and the modified Mayo wrist score was good (four patients) or excellent (thirty-seven patients) at a mean follow-up of thirty-six months (range, fourteen to sixty-eight months).
Pitfalls & Challenges
The transtrapezial approach for fixation of acute scaphoid fractures facilitates precise percutaneous placement of a screw along the central axis of the scaphoid, which has been shown to be biomechanically superior to a more eccentric screw position1,2.
The transtrapezial approach provides access to the central axis of the scaphoid and turns a technically demanding procedure into a straightforward operation if …
Enter your JBJS login information below.