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

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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

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

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

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).

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

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

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

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

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

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

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

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

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

Computed tomography scan showing bridging bone.

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

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