The scaphoid bone, located in the wrist, plays a crucial role in wrist stability and function. Due to its unique blood supply and anatomical position, fractures of the scaphoid are common yet challenging to treat. Among the various treatment options, percutaneous scaphoid screw fixation has emerged as a minimally invasive and effective technique for managing scaphoid fractures. This article provides an in-depth look at the percutaneous scaphoid screw procedure, its indications, surgical technique, benefits, risks, and outcomes.
The scaphoid is one of the eight small carpal bones in the wrist, situated on the thumb side, bridging the proximal and distal rows of carpal bones. It is essential for wrist motion and load transmission. The scaphoid’s blood supply is primarily retrograde, entering distally and traveling proximally, which makes the proximal pole vulnerable to avascular necrosis (bone death due to lack of blood supply) after fracture.
Scaphoid fractures are common, especially in young, active individuals, often resulting from a fall on an outstretched hand. These fractures can be difficult to diagnose and treat because:
The primary goals of treatment are to achieve stable fixation, promote bone healing, restore wrist function, and minimize complications.
Percutaneous scaphoid screw fixation is a minimally invasive surgical technique used to stabilize scaphoid fractures using a specially designed screw inserted through a small skin incision. The screw compresses the fracture fragments, promoting bone healing while preserving the surrounding soft tissues.
This technique contrasts with traditional open surgery, which requires a larger incision and more extensive dissection, potentially disrupting blood supply and delaying recovery.
It is important to note that severely displaced fractures, comminuted fractures, or those with significant bone loss may require open surgery or bone grafting.
Before surgery, a thorough clinical and radiological assessment is essential:
The percutaneous scaphoid screw fixation procedure generally follows these steps:
Anesthesia and Positioning: The patient is placed supine with the arm on a radiolucent hand table. Regional or general anesthesia is administered.
Imaging Guidance: Fluoroscopy (real-time X-ray) is used throughout the procedure to guide screw placement.
Approach: A small skin incision (usually 1-2 cm) is made either on the volar (palmar) or dorsal side of the wrist, depending on fracture location and surgeon preference.
Guidewire Insertion: Under fluoroscopic control, a guidewire is carefully advanced across the fracture site, ensuring proper alignment and central placement within the scaphoid.
Drilling and Tapping: A cannulated drill is passed over the guidewire to prepare the screw path. Tapping may be performed if necessary.
Screw Insertion: A headless, cannulated compression screw (such as a Herbert or Acutrak screw) is inserted over the guidewire. The screw compresses the fracture fragments, promoting stability and healing.
Verification: Final fluoroscopic images confirm correct screw position and fracture reduction.
Closure: The small incision is closed with sutures or steri-strips, and a sterile dressing is applied.
Postoperative management typically includes:
While percutaneous fixation is generally safe, potential complications include:
Proper surgical technique and patient selection are critical to minimizing these risks.
Percutaneous scaphoid screw fixation represents a significant advancement in the treatment of scaphoid fractures. By combining minimally invasive techniques with stable internal fixation, it offers patients a faster, safer, and more effective path to recovery. Proper patient selection, meticulous surgical technique, and comprehensive postoperative care are essential to achieving optimal outcomes.
If you suspect a scaphoid fracture or have been diagnosed with one, consult an orthopedic specialist to discuss whether percutaneous scaphoid screw fixation is the right treatment option for you.