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Updated: Nov 18, 2025

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Percutaneous Scaphoid Fixation: Experience Value among Different Approaches.

Nuno Ramos-Marques1, Ana Ferrão1, Bruno Morais1

  • 1Deparment of Orthopedic Surgery, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, EPE, Lisboa, Portugal.

Journal of Wrist Surgery
|February 8, 2021
PubMed
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Surgeon experience significantly impacts screw placement accuracy in percutaneous scaphoid fixation. For less experienced surgeons, the dorsal approach may offer better outcomes for scaphoid waist fractures.

Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Surgical Techniques

Background:

  • Percutaneous scaphoid osteosynthesis is a growing treatment for acute scaphoid fractures.
  • It offers an alternative to conservative management for selected cases.
  • Assessing screw positioning accuracy is crucial for successful outcomes.

Purpose of the Study:

  • To evaluate the radiographic accuracy of screw placement in percutaneous scaphoid fixation.
  • To analyze the influence of surgeon experience on screw positioning.
  • To compare screw positioning accuracy between volar and dorsal surgical approaches.

Main Methods:

  • Retrospective review of 39 patients with scaphoid waist fractures (Herbert's B2) treated from 2013-2019.
  • Inclusion criteria: age 18-55, dominant hand, manual labor, 6-month follow-up, no associated lesions.
Keywords:
dorsal/volar approachexperiencepercutaneous fixationpositioningscaphoid fracture

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  • Radiographic assessment by a hand surgeon, general orthopaedic surgeon, and resident, evaluating screw axis, prominence, reduction, and fracture site.

    • Main Results:

    • A total of 39 patients underwent the procedure, with 10 using a dorsal and 29 a volar approach.
    • The hand surgeon's team achieved 83.3% correct screw positioning, compared to 42.9% for the other team.
    • No significant difference in accuracy was found for the dorsal approach, but the volar approach showed a statistically significant difference (p < 0.05) based on team experience.

    Conclusions:

    • Surgical team experience positively impacts screw positioning accuracy in percutaneous scaphoid fixation.
    • Dedicated hand surgery teams demonstrate superior results.
    • Less experienced surgeons may benefit from utilizing the dorsal approach for scaphoid waist fractures.