Arthroscopic Treatment of

Scaphoid Fractures & Nonunions

Aaron Venouziou, MDOrthopaedic Hand and Upper Extremity

SurgeonSt. Luke’s Hospital

Thessaloniki

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Scaphoid Fractures

• 70% of all carpal fractures

• Males

• Age between 15 – 30 years

• Common athletic injury

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Scaphoid Fractures

Healing Rate

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Scaphoid Fractures

• 6 – 8 weeks

• 3 months

• 5 – 6 months

Healing Time

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Scaphoid Fractures

• Muscle atrophy

• Disuse osteopenia

• Joint contracture

• Financial hardship

• Prolonged inactivity (≥6 months)

Nonoperative Treatment

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Scaphoid Fractures

• Proximal pole fractures

• Displacement > 1 mm

• Bone loss or comminution

• Angulated fractures (>35o)

• DISI deformity

• Perilunate fracture-dislocation

Operative Treatment

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Scaphoid Fractures

• Percutaneous fixation

• ORIF

• Arthroscopically assisted

percutaneous fixation

Operative Treatment

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Arthroscopically Assisted Percutaneous Fixation

• Fracture reduction

• Optimal guide wire positioning

• Evaluation of rigidity of fixation

• Assessment of screw length

• Assessment of associated soft

tissue injuries

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Arthroscopically Assisted Percutaneous Fixation

Central screw positioning

• Longer screw

• Better fixation

• Better union rate

Volar vs. Dorsal Approach

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Dorsal Arthroscopically Assisted Fixation

• Wrist flexion

• Ring sign

• Central axis on

AP/Lat/Oblique

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Dorsal Arthroscopically Assisted Fixation

• Traction tower

• Mini c-arm

• 30o wrist flexion

• Radiocarpal joint

through 3-4 portal

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Dorsal Arthroscopically Assisted Fixation

• 6R portal

• Needle in 3-4

portal

• Entry point

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Dorsal Arthroscopically Assisted Fixation

• Evaluation of fracture reduction

through mid-carpal portals

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Dorsal Arthroscopically Assisted Fixation

• A headless cannulated screw is

inserted down the central axis

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Scaphoid Nonunions

I Delayed presentation at 4-12 wk

II Fibrous union, minimal fx line

III Minimal sclerosis < 1 mm

IV Cystic formation, 1-5 mm

V Humpback deformity

VI Wrist arthrosis

Slade-Geissler Classification

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Scaphoid Nonunions

I Delayed presentation at 4-12 wk

II Fibrous union, minimal fx line

III Minimal sclerosis < 1 mm

IV Cystic formation, 1-5 mm

V Humpback deformity

VI Wrist arthrosis

Slade-Geissler Classification

Dorsal Arthroscopically Assisted Fixation

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Scaphoid Nonunions

I Delayed presentation at 4-12 wk

II Fibrous union, minimal fx line

III Minimal sclerosis < 1 mm

IV Cystic formation, 1-5 mm

V Humpback deformity

VI Wrist arthrosis

Slade-Geissler Classification

Dorsal Arthroscopically Assisted Fixation + Bone Graft

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