29 Open Reduction and Internal Fixation of Displaced Scaphoid Fractures via Dorsal Approach

Indications

• Acute unstable fractures
  
  
  
  • Displacement greater than 1 mm
    
  • Lateral intrascaphoid angulation greater than 35 degrees
    
  • Significant bone loss
    
  • Significant comminution
    
  • Concomitant ligamentous injuries
    
  • Fractures not amenable to closed reduction and cast treatment
  
  
• Relative indications
  
  
  
  • Multiple upper extremity injuries
    
  • Delayed union—4 to 6 months
    
  • Nonunion
    
  • Early return to sport/occupation

Figure 29-1

Technique

• 4 cm longitudinal incision ~4 cm on the ulnar border of Lister’s tubercle through the third compartment (Fig. 29-1).
  
• Identify extensor pollicis longus (EPL).
  
• Open overlying extensor retinaculum and elevate subperiosteally.
  
• Retract radial wrist extensors ulnarly, EPL radially.
  
• Expose dorsal wrist capsule and incise longitudinally, providing adequate exposure while preserving dorsal intercarpal ligament (Fig. 29-2).
  
• Reduce fragments using joystick K-wires and assess alignment with mini image intensifier.
  
• Place stable fixation with cannulated headless screw from proximal to distal over guide wire (Fig. 29-3).
  
• May use additional percutaneous K-wires for more rotational control.
  
• Close capsule without imbrication.
  
• Volar thumb gauntlet splint

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