Scaphoid Fractures

Abstract

Displaced scaphoid fractures with or without perilunate or lunate dislocations usually occur in the middle third of the scaphoid and usually require open reduction. An ideal fixation device that will lead predictably to union without complications has not been found. Compression screw fixation through a lateral approach has been technically difficult, and there have been a significant number of associated problems, including technical difficulty with the fixation, injuries to the radial nerve and artery, and nonunions. Using the volar approach of Matti and Russe, Herbert has described a relatively new screw technique that may be an improvement over previous efforts in both the approach and the implant (Figs. 21-1 A Figs. 21-1 B Figs. 21-1 C). We have used compression screw insertion with a volar MattiRusse incision and a technique similar to Herbert's but cannot yet testify to its success rate (Figs. 21-2 A-H). We have also used a compression staple for fractures of stable configuration in the middle three fifths of the scaphoid (Figs. 21-3 A-E). This has worked quite satisfactorily in most instances, although the wrist must be immobilized until union is assured (Figs. 21-4 A-D).