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.
Figures and Tables
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.
![jkoa-42-530-g001](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-42-530-g001.jpg)
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.
![jkoa-42-530-g002](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-42-530-g002.jpg)
References
1. Adams BD, Blair WF, Reagan DS, Grundberg AB. Technical factors related to Herbert screw fixation. J Hand Surg Am. 1988. 13:893–899.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
2. Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br. 1996. 78:519–529.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Garcia-Elias M, Vall A, Salo JM, Lluch AL. Carpal alignment after different surgical approaches to the scaphoid: a comparative study. J Hand Surg Am. 1988. 13:604–612.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
4. Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br. 1998. 80:95–99.
6. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996. 29:602–608.
7. Kamineni S, Lavy CB. Percutaneous fixation of scaphoid fractures. An anatomical study. J Hand Surg Br. 1999. 24:85–88.
8. Lim JY, Lee HY, Song JH, Kang JW, Lee JY. Evaluation of the reliability, construct validity, and responsiveness of the Korean version of the DASH. J Korean Soc Surg Hand. 2005. 10:192–198.
9. Rettig AC, Kollias SC. Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med. 1996. 24:182–186.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10. Rettig ME, Raskin KB. Retrograde compression screw fixation of acute proximal pole scaphoid fractures. J Hand Surg Am. 1999. 24:1206–1210.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11. Shih JT, Lee HM, Hou YT, Tan CM. Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures. Arthroscopy. 2005. 21:620–626.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12. Slade JF, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res. 2006. 445:108–119.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
13. Slade JF 3rd, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2003. 85:Suppl 4. 20–32.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
14. Slade JF 3rd, Grauer JN, Mahoney JD. Arthroscopic reduction and percutaneous fixation of scaphoid fractures with a novel dorsal technique. Orthop Clin North Am. 2001. 32:247–261.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
15. Slade JF, Taksali S, Safanda J. Combined fractures of the scaphoid and distal radius: a revised treatment rationale using percutaneous and arthroscopic techniques. Hand Clin. 2005. 21:427–441.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
16. Sung IH, Jung JH, Lee KH, Choi CH, Yoon JP. Palmar percutaneous cannulated Herbert-Whipple screw fixation of scaphoid fractures. J Korean Soc Surg Hand. 2005. 10:129–135.
17. Taras JS, Sweet S, Shum W, Weiss LE, Bartolozzi A. Percutaneous and arthroscopic screw fixation of scaphoid fractures in the athlete. Hand Clin. 1999. 15:467–473.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
18. Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV. Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am. 2000. 82:633–641.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
19. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am. 1996. 78:1829–1837.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)