Comparison of conventional and transtrapezial palmar approaches for screw fixation of scaphoid waist fractures: a clinical study

Abstract

We investigated two palmar approaches for screw fixation of acute scaphoid waist fractures: the conventional percutaneous or transtrapezial approach. Thirty cases who underwent operation from 2013 to 2021 were reviewed (conventional group, 15; transtrapezial approach group, 15). Cross-sections were constructed along the long axis of the scaphoid on postoperative computed tomography to evaluate the screw position, relative to the centre point in the distal-third, midwaist and proximal-third of the bone. The screw could be inserted centrally in the proximal and distal regions using the transtrapezial approach. In the conventional approach, the screw was inserted radially in the distal region, but tended to be positioned centrally in the midwaist and proximal regions. As central placement of the screw in the proximal fragment offers a biomechanical advantage, both approaches can be options for some fracture patterns, while for others, the fracture pattern could influence which approach is better. Level of evidence: IV

Percutaneous fixation of scaphoid fractures through the snuffbox: an anatomical study

“…Recently, Tsumura et al (2022) compared the transtrapezial and conventional palmar approaches in a clinical study using postoperative CT scans. They concluded that both methods can be an option if the fracture is perpendicular to the centre line of the distal and middle-thirds of the scaphoid, as they both provide central placement of the screw while being perpendicular to the fracture plane.…”

“…The ideal screw should be both in line with the central axis of the scaphoid bone and perpendicular to the fracture plane, while having a direction allowing the longest screw to be inserted. However, meeting these three criteria at the same time is not possible, given the curvilinear shape of the scaphoid and the straightness of the screw (Tsumura et al., 2022). We believe that not all scaphoid fractures are suitable for fixation using a single approach.…”

“…Recently, Tsumura et al. (2022) compared the transtrapezial and conventional palmar approaches in a clinical study using postoperative CT scans.…”

“…In the same way, our data suggest that the dorso-radial approach could be considered for oblique fractures orientated around 60° from the scaphoid’s longitudinal axis. Tsumura et al. (2022) also suggested that both conventional palmar and transtrapezial approaches are options for some proximal fracture patterns.…”