Volar approach and screw fixation technique for fractures and non-unions of the carpal scaphoid

Delayed or non-union of the carpal scaphoid may be treated in a variety of ways. This article describes the operative technique and clinical results of a volar approach and screw fixation technique, which offers distinct advantages over other approaches. The volar approach to the scaphoid is simple, safe and rapid. It allows access to the fracture for fixation, the radioscaphoid joint for assessment and the distal radius for the procurement of a bone graft where necessary. Access to the volar aspect of the scaphoid is also biomechanically sound as it allows insertion of a wedge-shaped bone graft into the 'collapsed' area of the scaphoid in established non-unions. Compression screwing of the fracture site has the same advantages of stability and early mobilization that applies in other sites. Our clinical experience in 32 fractures has involved a low complication rate with early return of mobility and activity.