Percutaneous Fixation of Scaphoid Fractures

摘要

Acute scaphoid fractures have been treated for a long term by cast immobilization with satisfactory results in term of consolidation [1] Nevertheless, that type of treatment may lead to joint stiffness, muscle atrophy, local osteopenia, and the duration of immobilization has social and profesional consequences for young people. Lastly, prolonged plaster treatment has financial hardship for the patient and the society.Anatomical and biomechanical data give the justification of osteosynthesis of scaphoid .Indeed 80% of scaphoid is covered with cartilage [2] The fractures are essentially intra-articular fractures, with line reaching one of the 6 articular facets of bone.The bone supply is through radial artery,with a palmar pedicle for distal pole,and dorsal pedicle for 70% to 80% of proximal pole, without intraosseous anastomosis.Scaphoid is a very mobile bone whose integrity is essential in transmission of forces from hand to forearm [3]Fixation with compression leads to fracture stability, permits fracture healing and prevents nonunion or malunion who avoids intracarpal arthrosic evolution.Maudsley[4] T.H. Herbert [5] and other [6,7] designed new cannulated specifically screws for scaphoid, with special jigs,to prevent technical difficulties of fixation.Percutaneous fixation of scaphoid is an evolution of these techniques,first reported in German literature by Streli [8] then by Wozacek [9] and Ledoux [10] The approach may be dorsal or volar,and prevents damage of anterior radio-carpal ligaments [11] scaphotrapezial and radiocarpal joints,and preserve blood supply of the bone.Finally reduction and and per-operative control may be arthroscopically assisted.