PERCUTANEOUS FIXATION OF SCAPHOID FRACTURES

Indications

Percutaneous fixation of scaphoid fractures is performed for:

1. (a) Undisplaced scaphoid fractures in active individuals or multiple injuries.

2. (b) Do not use this technique if fractures are displaced >1mm.

Pre-operative assessment

Clinical assessment

• Assess vascularity of the hand, particularly the radial artery.

• Assess for evidence of neural compromise - particularly in the median nerve distribution.

• Assess the condition of the skin in the area of proposed incision.

• Assess for tenderness in other areas around the wrist which may represent a second injury.

Radiological assessment

• Anteroposterior (AP), lateral, 45? oblique and long-axis radiographs of the scaphoid.

• Assess scaphoid length and look for evidence of fracture collapse (hump-back deformity, loss of carpal height).

Operative treatment

Anaesthesia

• General or regional (axillary, supra- or infraclavicular block).

• Intravenous dose of antibiotic as prophylaxis prior to inflation of tourniquet.

Tourniquet

• Well-padded upper armcuff inflated to 250mmHg.

• Plastic exclusion drape to prevent any soaking of padding by skin preparation.

Equipment

• Percutaneousscrewsystemof choice with full selection of implants and screws.

• Radiolucent hand table securely fastened to operating table.

• Image intensifier or mini C-armfluoroscan.

Operating room set up

• The armmust lie centrally on the hand table.

• Surgeon is best seated at the distal end of the affected limb.

• Image intensifier or mini C-armis brought in from the head of the table throughout the procedure.