Sunday, December 4, 2016

Percutaneous reduction and fixation of the flexed fractured scaphoid

Here’s a neat technique..

17yo male with scaphoid waist fracture

CT reveals comminution

And a humpback deformity

You get the impression there is a pre-existing bone cyst through which the fracture occurred

Lunate extension secondary to scaphoid flexion

This is not the typical case for percutaneous fixation but:
1. a Matti-Russe approach and fixation with screws or a scaphoid plate is not without its problems
2. there is good evidence that stable fixation can obviate the need for bone grafting
3. ask yourself “Can this be done better?”

Well, maybe..

Traction applied

K wire is passed through the lunate

Lunate flexed relative to RCJ (extending scaphoid at the fracture site)

Two guide-wires passed across the fracture site

Scapholunate angle corrected on lateral view

Percutaneous screws

Lateral view to confirm acceptable SLA