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No scaphotrapezial joint degeneration seen with volar percutaneous transtrapezial approach
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Use of a volar percutaneous transtrapezial approach for fixing scaphoid fractures does not lead to significant radiographic degenerative changes at 6-years follow-up, according to researchers from Belgium.
“We think the transtrapezial approach offers all the advantages of a percutaneous technique,” Geert Meermans, MD, from the Lievensberg Hospital, said during his presentation at the 12th EFORT Congress 2011 in Copenhagen, Denmark. “It is fairly straightforward…easy to obtain central screw placements and at mid-term follow-up, does not lead to scaphotrapezial joint degeneration.”
‘Technically demanding’ procedure
Meermans and colleagues conducted a follow-up study to evaluate radiographic changes at the scaphotrapezial joint in 34 patients who underwent this procedure.
“Those of you who have tried to put a screw in the scaphoid know that it can be a very technically demanding procedure with less than optimal results, the screw can miss the scaphoid completely,” he said. “This can happen because of the shape of the scaphoid and the position of the scaphoid within the wrist, it may not be easily accessible.”
However, Meermans said using volar percutaneous fixation allows the surgeon to obtain central screw placement by resecting part of the trapezium, manipulating the scaphoid or using a transtrapezial approach.
Clinical outcomes
The study included patients with isolated, nondisplaced scaphoid wrist fractures who were treated with volar percutaneous transtrapezial screw fixation. The mean age of the patients was 34 years. All patients were operated on within 2 weeks after the initial trauma.
Follow-up 6 years later consisted of radiographic studies and clinical examination. Results were graded with use of the Visual Analog Scale (VAS) and modified Mayo wrist score. Degenerative changes at the scaphotrapezial joint were staged using the modified Eaton and Glickel classification.
Clinical results showed no significant differences in VAS scores between the injured and uninjured side, similar range of motion, grip strength and key pinch strength, according to Meermans. In addition, the mean VAS score was 0.4 and mean modified Mayo wrist score was 93, with 29 excellent and five good results.
As for radiographic results, 31 patients showed no degenerative changes at the scaphotrapezial joint; three patients had some changes; two patients had bilateral changes; and one patient had asymptomatic degenerative changes at the joint, which Meermans believes was caused by asymptomatic screw protrusion at the distal portal.
Meermans said the advantages of volar percutaneous transtrapezial include easier central screw placement, without the need for manipulation of the wrist or special equipment.
“There is less risk of injury to the palmer blood supply, and it has shown excellent to good short- and mid-term results,” he said. – by Tara Grassia
Reference:
- Meermans G, Van Riet R, Ghislain G, et al. Percutaneous transtrapezial approach to scaphoid fractures does not lead to ST degeneration. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.
- Geert Meermans, MD, can be reached at the Lievensberg Hospital, Bergen Op Zoom, the Netherlands; email: geertmeermans@hotmail.com.
- Disclosure: Meermans has no relevant financial disclosures.