Scaphoid AARIF Arthroscopically Assisted Reduction and Internal Fixation of Scaphoid Fractures

摘要

The unstable scaphoid fracture can be treated by a variety of different methods including open reduction and internal fixation CORIR, percutaneous fixation with either K-wires or cannulated screws, and arthroscopic-assisted reduction and internal fixation (AARIF) with various cannulated screw systems. The drawbacks of ORIF include extensive soft-tissue dissection, disruption of the nondominant volar blood supply, division of the radioscapho-capitate and/or radiolunate ligaments and volar capsule, and prolonged rehabilitation. Percutaneous fixation avoids the aforementioned drawbacks yet relies on fluoroscopic guidance alone to ensure accurate reduction of the scaphoid fracture fragments and optimal positioning of the implant in the central third axis of the scaphoid. The frank technical limitations of plain radiography as well as fluoroscopy in detailed visualization of the oddly oriented scaphoid finitely limit the accuracy of the percutaneous technique. AARIF avoids all the limitations of ORIF yet allows direct visualization of the scaphoid fracture site and ensures accurate reduction of the fragments before and during definitive arthroscopically assisted internal fixation. AARIF also assists in accurate targeting of the proximal pole apex or "sweet spot" assuring central third scaphoid axis placement in addition to allowing detection of concurrent pathology in the radiocarpal or midcarpal joints. Scaphoid AARIF is a convenient therapeutic alternative that avoids many of the inherent pitfalls of ORIF and percutaneous fixation.