Volar approach to percutaneous fixation of acute nondisplaced fractures of the scaphoid

Scaphoid fractures typically occur in young, healthy males at the peak of their employment and productivity, and left untreated or inadequately treated will ultimately progress to nonunion and a "predictable" pattern of wrist arthritis and carpal collapse. Nonoperative treatment of these fractures requires prolonged cast immobilization, which can lead to wrist stiffness, loss of grip strength, muscle atrophy, and protracted loss of economic productivity. To prevent these devastating sequelae, percutaneous techniques for scaphoid fixation have been described and popularized; however, these techniques are technically demanding as optimal position of the compression screw is required to achieve bony union. The focus of this paper is to describe the indications, contraindications, and a series of reproducible, practical pearls to achieve ideal percutaneous scaphoid compression screw fixation of scaphoid waist and distal pole fractures.