Acute percutaneous scaphoid fixation using a cannulated screw

Fractures of the scaphoid are most commonly seen in young males where immobilisation in a cast will lead to a prolonged period away from work and from athletic activities. Early rigid fixation has recently been advocated to promote a rapid functional recovery. Open reduction and internal fixation of the scaphoid is however technically demanding, damages the anterior radiocarpal ligaments, violates the scapho trapezial joint, further endangers the already compromised blood supply of the scaphoid and not infrequently leads to troublesome hypertrophic scars. These problems can be overcome in minimally displaced or undisplaced fractures by percutaneous fixation. We present the first 50 cases from our ongoing study of patients treated acutely in this way. No cast immobilisation was used and the patients were allowed to mobilise immediately postoperatively. Union was obtained in all cases after an average of 55 days (37-79). Range of movement at the time of fracture union was equal to that of the contralateral limb at three months and grip strength was 98% of the contralateral side at three months. Patients returned to sedentary work within 4 days and to manual work/sports within 5 weeks. We have found percutaneous scaphoid fixation for acute fractures a rapid and very satisfactory intervention which leads to a rapid functional recovery.