Minimally invasive management of scaphoid fractures

Abstract

Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. This technique is appropriate for both acute scaphoid waist and proximal pole fractures, as well as selected nonunions. A headless cannulated compression screw (standard Acutrak) is implanted via a dorsal percutaneous approach using fluoroscopy and arthroscopy to confirm position and reduction. The details of this technique are reviewed. In a consecutive series of 27 fractures treated with arthroscopic assisted dorsal percutaneous fixation, eighteen fractures were treated acutely and 9 were treated more than 1 month after injury. CT scan confirmed 100% union rate at an average of 12 weeks with no complications.