A Palmar percutaneous volar versus a dorsal limited approach for the treatment of non- and minimally-displaced scaphoid waist fractures: an assessment of functional outcomes and complications

Non-displaced or minimally displaced scaphoid waist fractures can be surgically treated using either the percutaneous volar or the limited dorsal approach.These techniques provide a possibility of early wrist physiotherapy throughout the healing period, better functional outcomes and a shorter sick leave duration.Many reports cite low complication rates.The purpose of this study is to compare both techniques based on the complication rate and functional outcomes. The authors compared 42 patients treated for an acute scaphoid waist fracture by percutaneous osteosynthesis and 38 patients treated by osteosynthesis using a limited dorsal approach after a follow-up of at least 12 months. The differences between the groups were tested statistically. The overall complication rate was 11.9% for the percutaneous approach and 15.8% for the dorsal approach. There was one case of non-union in each group. The differences in the complication rates as well as in the range of wrist motion and in persistent complaints were statistically insignificant. We found significantly (p=0.042) better grip strength for the percutaneous approach. Most of the complications detected were due to a technical error during surgery and can be minimized by meticulous adherence to the technique. The difference in grip strength is very close to the significance level set for the study, and this will be necessary to clarify in a planned prospective study. Based on the statistical analysis of the results of our clinical data, the two techniques are comparable.