"Bullseye" Fluoroscopic View to Assess Center Scaphoid Screw Placement: Surgical Technique

Percutaneous headless screw fixation is an effective, minimally invasive treatment option for select individuals with nondisplaced or minimally displaced scaphoid waist fractures. While both volar and dorsal approaches have been described, fixation rigidity is optimized by screw placement down the center axis of the scaphoid. This is crucial, as the central axis placement of the screw allows for more stable fracture fixation. Intraoperative fluoroscopic confirmation is critical to ensure optimal center axis or near-central axis placement of both the guide pin and ultimately the final headess screw within the scaphoid. Traditionally, intraoperative guide pin and screw position is assessed utilizing live fluoroscopy by rotating the wrist to obtain AP, PA, oblique and lateral views. We present unique, intraoperative "perfect dot" and "bullseye" fluoroscopic views that allow for more accurate confirmation of central axis or near-central axis guide pin and headless screw placement-views that are applicable for both percutaneous and open scaphoid fixation.