Percutaneous screw fixation of scaphoid fractures surgery percutaneous screw fixation of scaphoid fractures surgery type of operation day case length of procedure 0. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Previous studies have shown advantages to placing the screw through the bone center of mass. Be sure that the fracture is suitable for percutaneous technique, and that no secondary displacement has occurred.
Percutaneous treatment for waist and proximal pole scaphoid fractures. The purpose of this study was to quantify the rate of tendon, nerve and vessel injury in the dorsal percutaneous technique for the fixation of scaphoid fractures. The procedure could be performed under biers block anaesthesia. A new technique for targeting the central axis is described, which simplifies the process of achieving reduction and fixation. We describe a percutaneous technique for screw fixation of all types of fractures of the scaphoid. Alashhabelbegawi19990c85f617e0f8a6a04bc2f474dd15ae9b3f2a. Correction of humpback deformity the humpback deformity must be corrected to allow stable screw fixation in the long axis of the scaphoid and to prevent arthrofigure 5 a standard russe incision is drawn along the course of the flexor carpi radialis, extending along the.
For minimally displaced or undisplaced b1 or b2 fractures, these problems can be overcome by percutaneous fixation. Percutaneous and open techniques for scaphoid screw fixation. We report our technique and the results of a pilot study in 15 patients. Percutaneous techniques with or without arthroscopy assistance have been advocated as less invasive surgical approaches that may have an added benefit in the athlete. At first, percutaneous techniques of scaphoid fracture reduction and fixation may appear daunting. In an effort to diminish the time to union and decrease prolonged immobilization, percutaneous fixation techniques have been described and recently popularized by several authors. Percutaneous fixation of stable scaphoid fractures mayo clinic.
Percutaneous scaphoid fracture fixation has many advantages over the open method of fixation. Percutaneous screw fixation of undisplaced fractures of the scaphoid waist has gained popularity but remains technically demanding. Volar percutaneous screw fixation for scaphoid nonunion. The surgical technique of this approach is described. Surgical technique percutaneous scaphoid fixation using the acutrak screw. Internal fixation indicated for displacement 1mm percutaneous fixation recommended only for non. We recommend a 1 cm incision centred over the scaphotrapezial joint and dissection under direct vision to the entry point in the scaphoid rather than a completely percutaneous approach. Abstract recent advances in techniques and implants have led to renewed interest in percutaneous screw fixation of acute scaphoid fractures. Pdf percutaneous screw fixation for scaphoid fractures. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable. Volar percutaneous transtrapezial fixation of scaphoid. However, with experience, they offer a powerful and versatile capability that is demonstrating promising results in the treatment of notoriously difficult fractures and nonunions.
Mar 21, 2017 28 percutaneous screw fixation of scaphoid fractures indications acute nondisplaced and displaced fractures of the scaphoid fractures in competitive athletes or laborers or other individuals who wish to avoid prolonged periods of immobilization and a faster return to activity fractures with delayed treatment technique the patient is positioned supine with the arm extended and the. Do you want to use the redesigned ao sr like an app. More generally, percutaneous, via its latin roots means, by way of the skin. Percutaneous scaphoid fixation wheeless textbook of. We describe the anatomical basis for a safe percutaneous approach. If anatomic reduction of the fracture is not possible by closed means, percutaneous fixation should not be attempted. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable scaphoid fractures will be the focus of this paper. Your digital gateway to expertise, education, and innovation. Percutaneous cannulated screw fixation pcsf of acute scaphoid fractures has been shown to consistently produce good results.
Recent publications report the use of percutaneous techniques in the treatment of delayed and nonunions of the scaphoid. The closed cast treatment of acute scaphoid fractures generally has good outcome, with bony union resulting. An example would be percutaneous drug absorption from topical medications. Analyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result. Fixation with herbert screw for scaphoid fracture is an effective and convenient way of treatment with satisfactory functional outcome and less complication. Developing and evaluating computerassisted surgical.
Anatomical landmarks for volar percutaneous scaphoid screw. Percutaneous transtrapezial fixation of scaphoid fractures. Percutaneous fixation of stable scaphoid fractures. Both dorsal and volar approaches for psf of the scaphoid have been described. That technique is the use of arthroscopy and percutaneous reduction rather than an open exposure to achieve reduction and fixation of acute displaced scaphoid fractures. Volar percutaneous screw fixation for scaphoid waist delayed. Percutaneous screw fixation of scaphoid fractures has gained popularity over the years. Volar percutaneous transtrapezial fixation of scaphoid waist. Scaphoid, navigation, fracture fixation, osteosynthesis, screw insertion introduction. The percutaneous antegrade scaphoid fracture fixationa safe. Scaphotrapezial arthritis progression was never noted in this series. Fractures of the scaphoid are most common in young men. Percutaneous transtrapezial fixation of acute scaphoid. For scaphoid waist fractures without collapse, percutaneous screw fixation.
Nov 10, 2009 percutaneous fixation of scaphoid fractures with headed cannulated screws was first performed in germany by streli, beginning in 1962, as modification of the technique of open reduction with solid bone screws of mclaughlin. A technical note on percutaneous scaphoid fixation using a hybrid technique. The patients were evaluated at a mean of 36 months range 1468 months after surgery. Percutaneous scaphoid compression screw fixation youtube. Percutaneous screw fixation of scaphoid waist fracture non. Percutaneous screw fixation is widely used in acute fractures of the scaphoid. Cerclage wire fixation of navicular body fractures a treatment based on mechanism of injury. Scaphoid approach to dorsal fixation using acutrak 2 screw with dr. This technique is known as the modified seldinger technique. In this study, we used radiographs and biomechanical tests. Scaphoid screw dorsal approach 2 kwire insertion access the proximal pole fragment using a percutaneous technique or limited incision approach in the vicinity of listers tubercle over the radiocarpal joint. Materials and methods the forearm and hand from 40 cadavers embalmed according to thiels method were used. Volar percutaneous screw fixation of the scaphoid is a welldescribed technique for the treatment of scaphoid waist fractures with good clinical outcomes. Under fluoroscopy control, and with the wrist hyperextended, the guidewire for the cannulated screw system was placed through the volar scaphoid tuberosity, directed along the proximal aspect, dorsally, and ulnarly slightly diagonal to the longitudinal axis of the scaphoid and across the fracture site.
Jul 25, 20 percutaneous fixation of scaphoid fracture besthandsurgeon. Percutaneous fixation of selected scaphoid fractures by dorsal. Between march 2011 and march 2015, the authors treated 15 scaphoid fractures using the percutaneous scaphoid fixation technique. This study describes a transtrapezial modification of the volar p. Percutaneous fixation of scaphoid fracture youtube. Acute percutaneous scaphoid fixation semantic scholar. The video shows the percutaneous transtrapezial fixation of a scaphoid fracture. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable scaphoid. However, it is unclear whether the dorsal approach leads to better clinical outcomes than the volar approach. The acutrak screw is a headless, highly polished, tapered, self tapping, fully threaded, cannulated device designed to provide interfragmentary compression. Scaphoid fixation approaches cambridge orthopaedics. Fixation of acute and selected nonunion scaphoid fractures. In this study, we aimed to present our results with volar percutaneous screw fixation in patients with scaphoid nonunions.
During a 15year period ending in 1984, 280 cases were treated by this method. We now have a clinical study ready with 73 months average follow up on 29 cases, showing no degenerative changes at stt joint. Aug 11, 2009 volar percutaneous cannulated screw fixation of acute scaphoid waist fractures has been used commonly by many authors, reportedly with uniformly high union rates approaching 100%, excellent functional results, rare complications, quicker time to union, and early return to manual work 1, 3, 9, 21. This is a surgical video intended for patient educational purposes. Technique for percutaneous fixation of displaced and nondisplaced acute scaphoid fractures and select nonunions. Pdf percutaneous fixation of scaphoid fractures an. Scaphoid fixation approaches volar dorsal percutaneous dorsal percutaneous volar. More often, percutaneous is typically used in reference to placement of medical devices using a needle stick approach.
The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. Twelve cadaveric upper limbs were used for this study. Scaphoid fracture percutaneous fixation with the 3. This metaanalysis compared clinical outcomes, including the incidence of nonunion, postoperative complications, overall. Prof prakash kotwal, professor of orthopaedics, aiims, newdelhi. Comparison of dorsal and volar percutaneous approaches in.
The technique allows exact central placement of the screw, without the need to manipulate the wrist. The starting point for the dorsal approach is the scapholunate joint, and either the scaphotrapezial joint or the transtrapezial method is used for the volar approach. Cannulated screws were inserted into 32 cadaveric scaphoids through 1 cm palmar incisions. Displaced and unstable fractures should be approached with a volar or dorsal open technique to achieve and confirm an anatomic reduction before screw placement. Percutaneous screw fixation psf is a popular treatment for nondisplaced or percutaneously reducible scaphoid waist fractures. Percutaneous scaphoid fracture fixation activity you may not bear weight on the operated hand until permitted by your surgeon. Splint keep the splint on at all times, we will remove this during your visit to the clinic.
Clearly, however, a percutaneous approach can be challenging, as demonstrated by the recent paper from bushnell et al. Arthroscopically assisted reduction and percutaneous. Extraction of cannulated percutaneous screw from scaphoid. Mammoth orthopedic institute 85 sierra park road mammoth lakes, ca 93546 760. Both palmar and dorsal approaches can be used for fixation of scaphoid fractures. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply. Consequently, percutaneous screw fixation is appealing for the young and active population. Scientific paper percutaneous fixation of acute scaphoid fracture. It is safe and easy percutaneous screw fixation of scaphoid fractures via the volar approach. Insertion device for volar percutaneous fixation of nondisplaced scaphoid fracture. Aug 07, 2015 percutaneous screw fixation has been advocated for minimally displaced acute scaphoid fractures and was recently reported for displaced scaphoid fractures 1, 5. Percutaneous, transtrapezial fixation without bone graft. Scaphoid percutaneous screw fixation orthopedic coding. Percutaneous fixation of scaphoid fractures puts the superficial palmar branch of the radial artery at risk.
The disadvantages of a long period of cast immobilisation are avoided and this technique allows a more rapid return to work and sports activities than conservative treatment. When a surgeon uses a percutaneous volar approach to treat scaphoid waist fractures, central screw placement is complicated by the shape of the scaphoid and by obstruction by the trapezium. Fixation of navicular body fractures with a cerclage wire technique. Conirm kwire placement with carm on multiple views. Percutaneous fixation of selected scaphoid fractures by. Pdf percutaneous screw fixation for fractures of the. Abstract this dissertation presents a thesis on the use of additive manufacturing in the development and evaluation of a computerassisted system for wristfracture repair. A technical note on percutaneous scaphoid fixation using hybrid technique. Scientific paper percutaneous fixation of acute scaphoid. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical. Percutaneous fixation of acute scaphoid fractures offers rigid fixation and potentially improved healing rates without either open surgical dissection or prolonged cast immobilization. It is less invasive and avoids damage to the radiocarpal ligaments. Pdf percutaneous screw fixation for fractures of the scaphoid. Scaphoid fixation can be quite difficult due to the cashew nut shape and the need to place the screw in the midaxis of the scaphoid, without violating the radial and ulnar articular surfaces.
Such percutaneous techniques have been described by. Technique for percutaneous fixation of displaced and. Anatomical landmarks for volar percutaneous scaphoid screw fixation. Volar percutaneous screw fixation for scaphoid waist. A few reports have described the percutaneous approach for treating scaphoid delayed unions and nonunions 3, 10. Computer optimized screw placement for volar percutaneous. Pdf comparison of two percutaneous volar approaches for. This study describes a transtrapezial modification of the volar percutaneous technique and reports the results in 41 patients. Anatomical landmarks for volar percutaneous scaphoid. Passing the guide wire using our anatomical landmarks and technique was very reliable and reproducible.
The patient has given full written consent for the filming and use of this video. Percutaneous fixation of scaphoid fractures through dorsal approach gives. The dorsal approach allows better central screw placement along the long axis of the scaphoid compared with the volar approach in managing acute scaphoid fractures. Surgery percutaneous screw fixation of scaphoid fractures. To evaluate the clinical outcome of patients with acute scaphoid fractures treated by percutaneous screw fixation.
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