Open Reduction and Internal Fixation of Scaphoid Nonunion via Palmar Approach with Distal Radial Bone Graft

30 Open Reduction and Internal Fixation of Scaphoid Nonunion via Palmar Approach with Distal Radial Bone Graft

Indications

Scaphoid fails to heal after 3 months. Radiographs show resorption of bone with sclerosis along the edges of the fracture.

Pearl

If, on a lateral view, the scaphoid has collapsed into a “humpback deformity” (Fig. 30-1), consider correcting this deformity with a wedge of iliac crest or distal radius bone graft.

Figure 30-1

Technique

Brunner incision along the radial aspect of the flexor carpi radialis (FCR) tendon (Fig. 30-2).
Retract the FCR tendon ulnarly and incise the floor of the FCR sheath (Fig. 30-3).

Figure 30-2

Figure 30-3

Pitfall

The palmar cutaneous branch of the median nerve runs along the ulnar aspect of the FCR tendon. The nerve is at risk if the dissection strays ulnar to the FCR tendon.