Specificities of scaphoid fractures:
The scaphoid is one of the main bones of the wrist, it belongs to the first row of the carpal bones. Scaphoid vascularity is poor, as its blood vessels come from the distal pole only, which accounts for its difficult consolidation, particularly in fractures of the proximal pole (close to the radius), located further away from the source of supply. Arthroscopic wrist surgery makes it possible to preserve scaphoid vascularity as much as possible and favour its consolidation.
Video of arthroscopic wrist surgery for a scaphoid fracture:
Scaphoid fracture diagnosis:
Diagnosing a scaphoid fracture is not so simple as the fracture may be invisible on the initial x-ray. In this case, persisting wrist pain leads to perform a CT scan of the wrist on which the diagnosis can be based. Because diagnosis is difficult, it is common to for scaphoid fractures to be diagnosed late and the CT scan makes it possible then to determine how old the fracture is and to rule out non-union. Shown here is a fracture of the scaphoid’s middle third, with little displacement, confirmed by the CT scan.
Treatment of scaphoid fractures by arthroscopic surgery:
Arthroscopic wrist surgery for scaphoid fractures improves surgical safety and greatly shortens recovery and immobilization which for recent scaphoid fractures will not exceed 15 days.
Scaphoid fractures require good command of arthroscopic wrist surgery techniques, which are specialized surgery techniques. Surgery is performed on an outpatient basis under regional anaesthesia, with the patient comfortably positioned in the supine.
In non-displaced scaphoid fractures, surgery begins by fixing the fracture site with 2 K-wires under fluoroscopic monitoring.
<img alt="Arthroscopic" surgery="" of="" scaphoid="" fracture,="" operative="" setup,="" toulouse"="" data-cke-saved-src="/sites/default/files/scaphoide-3-installationnew.jpg" src="/sites/default/files/scaphoide-3-installationnew.jpg" style="width: 250px; height: 333px; float: left;" title="Arthroscopic surgery of scaphoid fracture, operative setup, Toulouse">
Once the scaphoid fracture is fixed, arthroscopy through the radiocarpal portal can begin. The wrist is positioned vertically, under light traction, which allows decoaptation of the wrist’s joints.
Joint bleeding and bubbles will be sucked out with a needle. The perifracture haematoma will be removed with the shaver under arthroscopic monitoring.
The scaphoid fracture site can then be perfectly visualized. From the fracture site, it is possible to see the pins that have been left protruding into the joint deliberately to confirm their perfect positioning.
Scaphoid fracture arthroscopy also makes it possible to assess associated lesions to the wrist’s ligaments, at the scapholunate but also the TFCC.
Two buried fixation screws are then inserted over the guide pins, achieving compression of the scaphoid fracture site.
The radiocarpal and mediocarpal arthroscopic views will confirm that the fixation screws do not cause any articular conflict and that reduction and compression of the scaphoid fracture site are perfect.
The guide pins can then be removed.
The surgical incisions are then closed with Steri-strip, no suture is needed for this wrist surgery.
This x-ray shows the post-operative result. The fixation hardware buried in the scaphoid will not need to be removed.
Recovery and recuperation after arthroscopic scaphoid fracture surgery:
For wrist immobilization, a removable splint is kept for 15 days. Sticking plasters on the hand will be necessary for 10 days. Basic daily activities with the wrist can resume at 15 days, rugby at 2 to 3 months.