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Arthroscopic Treatment of Scaphoid Non-union

March 01, 2017

Contributors: Francis Bonte, MD; Petrus Van Hoonacker, MD; Bert Vanmierlo, MD; Jean F Goubau, MD, PhD; Laurent B Willemot, MD; Laurent B Willemot, MD

Keywords: Nonunion

This video discusses the case presentation of a 24-year-old man who sustained a mid-waist scaphoid fracture after a fall onto his outstretched right hand. At 7 weeks postinjury, the fracture showed no signs of healing, and the patient elected to undergo surgical treatment. The patient underwent arthroscopic resection of the pseudarthrosis followed by bone grafting and percutaneous screw fixation. This video details the surgical technique. The patient is placed in the dorsal decubitus position and is administered general anesthesia. The exsanguinated, affected upper limb is placed on a side table. The skin is incised over the os trapezium. A Kirschner wire is introduced in the scaphoid in a retrograde manner. The limb is positioned for wrist arthroscopy. Using the classic radiocarpal portals, the joint is explored, and the fracture line is identified. Subsequently, the midcarpal joint is approached arthroscopically, and the pseudarthrosis is resected through a lesion-specific portal with the use of a burr. The limb is released from the tower, and the Lister tubercle is exposed and resected via a dorsal approach. A dedicated cancellous bone graft extractor is used to harvest required bone. The limb is repositioned for wrist arthroscopy. The cancellous bone grafts are introduced and impacted in the defect. A Herbert type screw is inserted over the initial guidewire, allowing stable fixation without undue compression of the bone grafts and the fracture. Radiographs and CT scans obtained 6 months postoperatively revealed solid bony union and excellent clinical results. The arthroscopic nature of the procedure allows for minimally invasive repair without release or injury to the intrinsic and extrinsic hand ligaments. The traction tower automatically corrects and reduces any humpback deformity. Kirschner wire positioning can be performed before pseudarthrosis resection, as presented in this video, or after pseudarthrosis resection. Maximal resection of the fibrous union is achieved via creation of an extra midcarpal portal, depending on lesion size and location. The capitate bone acts as a buttress, preventing distal migration of the bone grafts.

Results for "Hand and Wrist"