Open Reduction and Internal Fixation of Scaphocapitate Syndrome

Acute carpal fracture dislocations. After 2 to 3 weeks, the surgeon should consider a salvage procedure.

Arc of injury noted to enter through the scaphoid (S), extend across the capitate (C) neck, and exit through the lunotriquetral ligament (Fig. 42-1A,B).
Dorsal longitudinal incision.
Release the extensor pollicis longus from the third compartment and retract, with the radial wrist extensors in a radial direction.
Open the radial wall of the fourth extensor compartment and retract retinaculum and the common extensors in an ulnar direction.
Inspect the dorsal wrist capsule. The capsule is often avulsed from the distal radius. Identify the radiol-unotriquetral ligament so that it can be repaired at the end of the case.
Split the capsule along the dorsal radiocarpal and intercarpal ligaments elevating radially to expose the carpus and the radial styloid (Fig. 42-2).
Assess and document shearing injuries to the articular surface of the carpus.
Assess and document ligament injuries.
Small styloid fragments are excised if present.
Large styloid fragments (>1 cm) should be fixed because most will include part or all of the origin of the radioscaphocapitate ligament.