Percutaneous Internal Fixation of Selected Scaphoid Nonunions with an Arthroscopically Assisted Dorsal

Approach

by Joseph F. Slade, William B. Geissler, Andrew P. Gutow, and Greg A. Merrell

J Bone Joint Surg AmVolume 85(suppl 4):20-32

November 1, 2003

©2003 by The Journal of Bone and Joint Surgery, Inc.

The radiograph on the left suggests, and the arthroscopic image on the right confirms, a fibrous scaphoid nonunion.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Scaphoid nonunions with minimal sclerosis may demonstrate arthroscopic findings similar to those of fibrous scaphoid unions.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Eighty percent of the scaphoid surface is composed of articular cartilage, and its architecture is composed of multiple concave and convex surfaces, making the central axis a difficult target to

define (A and B).

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

The central axis of the scaphoid can be visualized with imaging.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

The distance between a mini-imaging unit's projection and receiving heads is approximately 14 in (36 cm).

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

With the wrist extended, imaging is used to confirm that the wire is in the correct position along the central axis in all planes.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

A complete arthroscopic examination includes visualization of the radiocarpal and midcarpal joints.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

After the arthroscopic survey is completed, the wrist is flexed and a guide-wire is driven from volar to dorsal.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Scaphoid length is determined by using two parallel guide-wires.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

A standard cannulated Acutrak hand drill is used, and the scaphoid is drilled not closer than 2 mm to the opposite distal scaphoid cortex.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

A standard-size screw, 4 mm shorter than the length of the scaphoid, is selected.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

In long-standing scaphoid nonunions, the texture of the bone changes.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.

Computed tomography scan showing bridging bone.

Joseph F. Slade III et al. J Bone Joint Surg Am 2003;85:20-32

©2003 by The Journal of Bone and Joint Surgery, Inc.