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Arthroscopic treatment of scaphoid fractures & nonunions

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Arthroscopic treatment of scaphoid fractures & nonunions

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Arthroscopic treatment of scaphoid fractures & nonunions

  1. 1. Arthroscopic Treatment of Scaphoid Fractures & Nonunions Aaron Venouziou, MD Orthopaedic Hand and Upper Extremity Surgeon St. Luke’s Hospital Thessaloniki www.handsurgery.gr
  2. 2. www.handsurgery.gr Scaphoid Fractures • 70% of all carpal fractures • Males • Age between 15 – 30 years • Common athletic injury
  3. 3. www.handsurgery.gr Scaphoid Fractures Healing Rate
  4. 4. www.handsurgery.gr Scaphoid Fractures • 6 – 8 weeks • 3 months • 5 – 6 months Healing Time
  5. 5. www.handsurgery.gr Scaphoid Fractures • Muscle atrophy • Disuse osteopenia • Joint contracture • Financial hardship • Prolonged inactivity (≥6 months) Nonoperative Treatment
  6. 6. www.handsurgery.gr Scaphoid Fractures • Proximal pole fractures • Displacement > 1 mm • Bone loss or comminution • Angulated fractures (>35o) • DISI deformity • Perilunate fracture-dislocation Operative Treatment
  7. 7. www.handsurgery.gr Scaphoid Fractures • Percutaneous fixation • ORIF • Arthroscopically assisted percutaneous fixation Operative Treatment
  8. 8. www.handsurgery.gr Arthroscopically Assisted Percutaneous Fixation • Fracture reduction • Optimal guide wire positioning • Evaluation of rigidity of fixation • Assessment of screw length • Assessment of associated soft tissue injuries
  9. 9. www.handsurgery.gr Arthroscopically Assisted Percutaneous Fixation Central screw positioning • Longer screw • Better fixation • Better union rate Volar vs. Dorsal Approach
  10. 10. www.handsurgery.gr Dorsal Arthroscopically Assisted Fixation • Wrist flexion • Ring sign • Central axis on AP/Lat/Oblique
  11. 11. www.handsurgery.gr Dorsal Arthroscopically Assisted Fixation • Traction tower • Mini c-arm • 30o wrist flexion • Radiocarpal joint through 3-4 portal
  12. 12. www.handsurgery.gr Dorsal Arthroscopically Assisted Fixation • 6R portal • Needle in 3-4 portal • Entry point
  13. 13. www.handsurgery.gr Dorsal Arthroscopically Assisted Fixation • Evaluation of fracture reduction through mid-carpal portals
  14. 14. www.handsurgery.gr Dorsal Arthroscopically Assisted Fixation • A headless cannulated screw is inserted down the central axis
  15. 15. www.handsurgery.gr Scaphoid Nonunions I Delayed presentation at 4-12 wk II Fibrous union, minimal fx line III Minimal sclerosis < 1 mm IV Cystic formation, 1-5 mm V Humpback deformity VI Wrist arthrosis Slade-Geissler Classification
  16. 16. www.handsurgery.gr Scaphoid Nonunions I Delayed presentation at 4-12 wk II Fibrous union, minimal fx line III Minimal sclerosis < 1 mm IV Cystic formation, 1-5 mm V Humpback deformity VI Wrist arthrosis Slade-Geissler Classification Dorsal Arthroscopically Assisted Fixation
  17. 17. www.handsurgery.gr Scaphoid Nonunions I Delayed presentation at 4-12 wk II Fibrous union, minimal fx line III Minimal sclerosis < 1 mm IV Cystic formation, 1-5 mm V Humpback deformity VI Wrist arthrosis Slade-Geissler Classification Dorsal Arthroscopically Assisted Fixation + Bone Graft
  18. 18. www.handsurgery.gr

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