Scaphoid

ORIF dorsal

• for uncomminuted proximal pole fractures <25%

Principles

• Exposes proximal pole
• Anterograde fixation
• Use mini accutrax or mini herbet as fragments are small

Equipment

• K wire driver
• Standard acutrax

Setup

• Prep & drape
  • Arm
  • Iliac crest

Landmarks

• Radial styloid
• Lister’s tubercle
• 3rd / 4th compartments

Incision

• Gently curved longitudinal incision over back of wrist centered to ulnar side of Lister’s tubercle
• Protect
  • superficial branches of radial nerve
  • scapholunate ligament

Exposure

• Free EPL from extensor retinaculum & retract ulnarly
• Excise synovitis
• Longitudinal incision in capsule on radial side of ECRL
• Exposes proximal pole of scaphoid

Fracture reduction

• Find fracture
• Curette
• Harvest bone graft
• Secure with acutrax wire
  • Special k wire with marker on it
• Under II
  • Measure (e.g. 25 mm)
  • Take away 4 mm )21 mm)
    • 2 mm for each end
  • then advance K wire further
• Hand drill
  • Over drill by 2 mm (e.g. 23 mm)
• Insert screw with cannulated screw driver
  • Check II
  • Remove K wire with K wire driver
• If you need to tighten
  • Use non cannulated screw driver
    • Because without wire in situ, you may break cannulated screw driver
• II

Closure

• 3.0 PDS to close capsule
• 4.0 nylon to skin
• Backslab (scaphoid type) for 10/7
• Then change to scaphoid cast for 6/52