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Arthroscopic Treatment of Scaphoid Non-union

March 01, 2017

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

This video illustrates the case of a 24-year-old man presenting with a mid-waist scaphoid fracture after a fall on his right outstretched hand. At seven weeks the fracture showed no signs of healing and surgical intervention was elected. The patient underwent arthroscopic resection of the pseudarthrosis followed by bone grafting and percutaneous screw fixation. The video details the surgical technique. The patient is positioned in dorsal decubitus under general anesthesia with the exsanguinated affected upper limb 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 with a burr through a lesion-specific portal. The limb is released from the tower and Lister’s tubercle is exposed and resected through a dorsal approach. A dedicated cancellous bone graft extractor is used to harvest the required amount of bone. The limb is repositioned for wrist arthroscopy. The cancellous bone grafts are introduced in de defect and impacted. Lastly, a Herbert type screw is inserted over the initial guide wire allowing stable fixation without undue compression of the bone grafts and fracture. Postoperative x-rays and CT scan demonstrate solid bony union after six months with excellent clinical results. The arthroscopic nature of the procedure allows for a minimal invasive repair without release or injury to the intrinsic and extrinsic hand ligaments. The traction tower set-up automatically corrects and reduces any humpback deformity if present. K-wire positioning can be performed before pseudarthrosis resection, as presented in this video, or afterwards. Maximal resection of the fibrous union is achieved by creation of an extra mid-carpal portal depending on lesion size and location. The capitate bone acts as a buttress preventing distal migration of the bone grafts.

Results for "Hand & Wrist"

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