Sports surgery - scaphoid fracture

Definition of scaphoid fractures:

In sports surgery, scaphoid fractures (the main wrist bone) are found in young athletes after violent sports injuries to the wrist. Arthroscopic sports surgery on the wrist greatly shortens postoperative recovery for athletes and immobilization, which will not exceed 15 days in recent scaphoid fractures.

Frequently caused by violent falls at rugby or football Scaphoid fractures are always caused by high velocity falls

 

Video of arthroscopic wrist surgery for a scaphoid fracture:

Video of sports surgery operation on scaphoid fracture performed using arthroscopy / Toulouse specialist

 

Diagnosis of scaphoid fractures:

This is a non-displaced fracture of the medial third of the scaphoid that can be confirmed by CT scan if in doubt.

Arthroscopic surgery of scaphoid fracture, pre-operative x-ray, ToulouseArthroscopic surgery of scaphoid fracture, pre-operative CT scan, Toulouse

 

Surgical treatment for scaphoid fractures:

This specialist surgery is performed on an outpatient basis under regional anaesthesia, with the patient comfortably positioned in the dorsal decubitus.
In non-displaced scaphoid fractures, surgery begins by fixing the fracture site with 2 K-wires under fluoroscopic monitoring.

Arthroscopic surgery of scaphoid fracture, operative setup, ToulouseArthroscopic scaphoid fracture surgery, initial pinning of fracture under fluoroscopic monitoring, providing temporary fixation of the fracture site, Toulouse

 

Once the scaphoid fracture is fixed, arthroscopy through the radiocarpal portal can begin.
Joint bleeding and bubbles will be sucked out with a needle. The perifractural haematoma will be evacuated using a shaver.

Arthroscopic scaphoid fracture surgery, bleeding and bubbles removal with a needle, ToulouseArthroscopic scaphoid fracture surgery, perifracture haematoma removal with shaver, Toulouse

 

The scaphoid fracture site can then be visualized perfectly . 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.‑
Arthroscopy also makes it possible to assess associated lesions to the wrist’s ligaments, at the scapholunate but also the TFCC.

Arthroscopic surgery of scaphoid fracture, fracture site vizualization, ToulouseArthroscopic surgery of scaphoid fracture, superior contusion of the scapholunate ligament, Toulouse

 

Two buried fixation screws are then placed on the guide pins, achieving compression of the scaphoid fracture site.
The radiocarpal and mediocarpal arthroscopic views will confirm that the fixation screws do not interfere with the joint and that reduction and compression of the scaphoid fracture site are perfect.

Arthroscopic surgery of scaphoid fracture, percutaneous double-screw fixation under compression, ToulouseArthroscopic scaphoid fracture surgery, verification of proper screw placement exactly under cartilage, Toulouse

 

The guide pins can then be removed.
The incisions are closed with Steri-strip.

This x-ray shows the post-operative result. The hardware will never need to be removed.

 

Arthroscopic surgery of scaphoid fracture, post-operative x-ray, ToulouseArthroscopic surgery of scaphoid fracture, post-operative splint to be kept for 15 days, Toulouse

 

Recovery after scaphoid fracture surgery

For immobilization, a removable splint is kept for 10 days. Basic daily activities with the wrist can resume after 10 days, rugby after 2 to 3 months.

Arthroscopic surgery of scaphoid fracture, palmar scar at 1 month, ToulouseArthroscopic surgery of scaphoid fracture, dorsal scar at 1 month, Toulouse