Comparative Review of Volar and Dorsal Techniques in Scaphoid Waist Fracture Fixation

Background: Scaphoid fractures are the most common type of carpal fractures, with the majority (approximately 70–80%) occurring at the waist region, an area with limited blood supply and high risk of non-union. Two primary approaches for internal fixation are the volar (retrograde) and dorsal (antegrade) techniques, but the optimal choice remains controversial. Objective: To evaluate the advantages and disadvantages of volar and dorsal approaches in the fixation of scaphoid waist fractures based on biomechanical, radiological, and clinical outcome data. Methods: A literature review was conducted on clinical, biomechanical, and radiological studies comparing both approaches, focusing on screw positioning, fixation stability, bone healing, complications, and functional outcomes (DASH, PRWE, VAS). Results: The dorsal approach allows for more central screw placement along the scaphoid axis, provides greater biomechanical stability, and avoids injury to volar ligaments. However, it poses risks to extensor tendons and the articular surface of the radius. Conversely, the volar approach is more suitable for distal fractures and deformity correction but carries a higher risk of injury to the STT joint. Functional outcomes and union rates between the two approaches show no clinically significant differences. Complications such as non-union and post-traumatic arthritis may occur, particularly with suboptimal screw positioning or delayed intervention. Conclusion: The success of scaphoid waist fracture fixation is more dependent on achieving central screw placement than on the surgical approach itself. Technique selection should be tailored to the fracture pattern and surgeon expertise to optimize healing and minimize complications. Keywords: Scaphoid fracture, volar approach, dorsal approach, central screw placement