Management of Diaphyseal fracture nonunion and delayed union ...
A. · A. 16 yo high school running back with worsening right wrist pain one year after scaphoid...
Transcript of A. · A. 16 yo high school running back with worsening right wrist pain one year after scaphoid...
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A.
16 yo high school running back with worsening right wrist pain one year after scaphoid nonunion surgery at another hospital. Xrays demonstrate a loosened screw, persistent nonunion and instability affecting the neighboring lunate bone.
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B.
Three dimensional reformat of high resolution computed tomographic scans to enable virtual surgical reconstruction.
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C. Right scaphoid
Injured 3D scaphoid compared to normal left scaphoid.
Normal scaphoid
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D.
Virtual surgical repositioning of fracture fragments, demonstrating need for bone graft to fill wedge defect in central scaphoid, and sized for appropriate screw length and position.
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E.
Exact size and dimensions of bone graft calculated.
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F.
Overlay of virtual reconstructed scaphoid on current scaphoid nonunion.
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G.
Surgical markings and operative fluoroscopy views of completed reconstruction and internal fixation of scaphoid and lunate.
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H.
Yellow arrow identifies strut of bone graft bridging nonunion site.
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I.
Healed scaphoid at 9 weeks postoperatively.
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