Excision Distal Pole of the Scaphoid

Indications

Symptomatic, long-standing scaphoid (S) nonunion with radioscaphoid arthritis
Margins of scaphoid nonunion sclerotic, with cystic changes in the proximal and distal poles; appearance suggests pseudarthrosis
Patient who is poor candidate for open reduction and internal fixation (ORIF): heavy smoker, anticipated poor compliance
No arthritis in the midcarpal joint

Pitfall

Patients with a marked dorsal intercalated segmental instability (DISI) deformity and pain emanating from the midcarpal joint are poor candidates for this procedure.

Figure 47-1

Technique

A dorsal, longitudinal 6 to 8 cm skin incision centered over the capitate (C) (Fig. 47-1)
Dissect to the wrist capsule using incisions along the dorsal radiocarpal and dorsal intercarpal ligaments creating a radial-based flap between the second and fourth compartments distal to the extensor pollicis longus (EPL) tendon.

Pearl

Incise the distal edge of the extensor retinaculum between the third and fourth compartments to the level of Lister’s tubercle to facilitate exposure (Fig. 47-2).