Percutaneous Screw Fixation for Distal Oblique Scaphoid Fractures: A Computed Tomography-Based Evaluation of the Dorsal and Volar Approach

Abstract

Background:

The scaphoid height-to-length (H/L) ratio assesses reduction quality, with lower values indicating better anatomic restoration and reduced malunion risk. We hypothesized that dorsal percutaneous fixation of acute, unstable distal oblique fractures yields a lower postoperative H/L ratio compared with volar fixation.

Methods:

We retrospectively reviewed all Herbert B1 fractures treated with percutaneous screw fixation at a single, tertiary referral center over 10 years. Dorsal and volar approaches followed standardized protocols, with guidewire placement under fluoroscopy and headless compression screw fixation. Postoperative computed tomography (CT) assessed the H/L ratio, intrascaphoid angle (ISA), and dorsal cortical angle (DCA), reformatted along the long axis of the scaphoid. Demographics, injury/operative characteristics, CT-based metrics, and clinical outcomes were compared between approaches.

Results:

A total of 18 patients met inclusion criteria (dorsal n = 10, volar n = 8), with an average follow-up of 7.3 months. The cohorts did not significantly differ in demographic, injury, or operative covariates. Computed tomography assessment showed similar ISA and DCA, but a lower H/L ratio in the dorsal approach cohort (0.64 vs 0.70, P = .040). While functional outcomes were mostly comparable, dorsal approach patients reported lower Disability of the Arm, Shoulder, and Hand scores at final follow-up (17.7 vs 45.5, P = .019). Two of the 18 patients developed nonunion; both were treated via a dorsal approach.

Conclusions:

A dorsal approach may achieve more anatomic reduction in percutaneous screw fixation of distal oblique scaphoid fractures, though it remains unclear whether the approach has any meaningful, relative influence on functional outcome and bone union.