J Korean Orthop Assoc.  2007 Aug;42(4):530-536. 10.4055/jkoa.2007.42.4.530.

Arthroscopic Reduction and Percutaneous Fixation of Scaphoid Fracture and Nonunion

• Kim BS
• Chung DH

• KMID: 2186516
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.530

Abstract

PURPOSE: To analyze the results of an arthroscopic reduction and percutaneous fixation of scaphoid fracture and nonunion.
MATERIALS AND METHODS
Fourteen scaphoid fractures or nonunion patients were analyzed clinically. There were 13 men and 1 woman, with a mean age of 30 (14-45) years. The average follow-up time was 13 months (12-18). Three cases had delayed union, 5 cases had nonunion and 6 cases had a fracture. After fluoroscopic reduction and an arthroscopic examination, the scaphoid was fixed with an Acutrak screw or K-wire percutaneously. The serial radiographs were checked by 2 weeks to confirm the bony union. The Mayo wrist score and DASH were used to assess the functional result at the final follow up.
RESULTS
Bony union was acquired in 13 cases in a mean time of 8 weeks. The mean Mayo wrist score was 86 points (60-100) with 7 excellent, 4 good, 2 fair and 1 poor case. The mean DASH was 11.1 points (0-63.3).
CONCLUSION
In scaphoid fracture and delayed union, good results could be obtained by an arthroscopic reduction and percutaneous fixation. However, in scaphoid nonunion, this technique should only be used in selected cases.

Keyword

Scaphoid; Arthroscopy; Percutaneous fixation

MeSH Terms

Arthroscopy
Female
Follow-Up Studies
Humans
Male
Wrist

Figure

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  Fig. 1 (A) With fluoroscopic guidance, after initially extending the wrist, a volar guide-wire was driven in a volar to dorsal direction after reducing the fracture. Next the wrist was flexed and a dorsal guide-wire was driven in the dorsal to volar direction. (B) An arthroscopic examination includes visualization of the fracture gap and integrity of the interosseous ligament. (C) A standard cannulated Acutrak screw, 4 mm shorter than the length of the scaphoid, was inserted.

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  Fig. 2 (A) Oblique radiograph of an 18-year old man shows scaphoid nonunion. (B) CT shows bone resorption and a gap at the scaphoid waist. (C) Postoperative 12 months posteroanterior radiograph of the wrist shows bony union and a volarly inserted screw.

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  Fig. 3 (A) Oblique radiograph of 20-year old man shows scaphoid delayed union. (B) CT shows a gap at the scaphoid waist. (C) Postoperative 12 months posteroanterior radiograph of the wrist shows bony union and a dorsally inserted screw.

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