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The Journal of Bone and Joint Surgery (American) 84:S21-S36 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Exhibits

Percutaneous Internal Fixation of Scaphoid Fracturesvia an Arthroscopically Assisted Dorsal Approach

Joseph F. Slade, III, MD, Andrew P. Gutow, MD and William B. Geissler, MD

Corresponding Author: Joseph F. Slade III, MD
Hand and Upper Extremity Service, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 73 Faulkner Drive, Guilford, CT 06437. E-mail address: joseph.slade{at}yale.edu

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Acumed, Incorporated, Beaverton, Oregon. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Acumed, Incorporated). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. A headless cannulated compression screw (standard Acutrak) is implanted by way of a dorsal percutaneous approach with the aid of fluoroscopy and arthroscopy to confirm screw position and fracture reduction. This technique is indicated in the correction of acute proximal pole fractures, acute waist fractures, and delayed unions that are not associated with avascular necrosis or collapse. The details of this technique are reviewed. In a consecutive series of twenty-seven fractures (seventeen waist fractures and ten proximal pole fractures) treated with arthroscopically assisted dorsal percutaneous fixation, computed tomographic scanning confirmed 100% union at an average of twelve weeks. Eighteen fractures were treated within one month after the injury, and nine were treated more than one month after the injury. In this series, the fractures that were treated early (less than one month after the injury) healed more quickly than those treated later.


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