Free Osteochondral Fragment

Fig. 8.1 By definition a free osteochondral fragment is not connected to ligaments. It is an ill-conceived notion that a disconnected, depressed fragment could reduce by ligamentotaxis alone. Arthroscopy is an ideal method for treatment in this dilemma.

Fig. 8.2 This 35-year-old IT engineer sustained a wrist fracture after a fall from a ladder. Initial care was given elsewhere. The length of the radius was restored by closed reduction, but the lack of a shadow from the rim of the scaphoid fossa remained worrisome.

Fig. 8.3 The cause of this was evident in the coronal slices: a free osteochondral fragment (FOF) impacted in the metaphysis. The area of compression involved two-thirds of the scaphoid fossa proper.

Fig. 8.4 The deformity was dramatically demonstrated on the sagittal view. The large FOF involving most of the scaphoid fossa was clearly delineated in S2.

Fig. 8.5 The exact position of the FOF was identified in the fragment view; the size was accurately estimated by using the measuring tool of the program (10 by 8 mm, and 6 mm sunken into the metaphysis). The yellow arrows indicate the rotation of the axis to achieve this view.

Fig. 8.6 In summary, this was a relatively easy lunate fossa fracture and a complex free osteochondral fragment corresponding to a large part of the scaphoid fossa to deal with. As previously discussed, we first needed to restore the length by using the least comminuted fragment (which in this patient happened to also be the lunate fossa).