chapter  13
10 Pages

Percutaneous Fixation of Acute Scaphoid Fractures

Fractures of the scaphoid are common injuries, representing

60-70% of carpal fractures (1,2). Inadequate treatment of these

injuries can result in nonunion, osteonecrosis, carpal instability

patterns, all of which can lead to impaired function, and

arthrosis (3-5). Early results of cast immobilization of acute

fractures were quite favorable, reporting union rates of 88-100%

and good motion, grip strength, and function (6-9). However,

subsequent series have shown more discouraging

results, particularly with fractures displaced more than 1 mm

(10,11). The first factor in initiating appropriate treatment is the

proper and timely diagnosis of these fractures. Once diagnosed,

the fracture can be managed by closed, open, or percutaneous

methods. Internal fixation has the advantage of providing

compression and a stable construct which can allow early

range of motion (ROM) (12-17). However, an open approach

risks stripping of the critical blood supply to the scaphoid and

also division of important carpal ligaments, such as the radio-

scaphocapitate ligament (18). Percutaneous techniques have

since been developed, providing the benefits of ORIF with a

smaller incision, preservation of the carpal ligaments and

potentially fewer wound problems.