Percutaneous Fixation Essay

DISCUSSION:

Percutaneous fixation of scaphoid fractures was first introduced by Streli in 1970. Then Herbert developed headless compression screw, and later Whipple modified it into a headless cannulated screw. Whipple also added the arthroscopic assisted reduction and for percutaneous fixation of scaphoid fractures 38.

Since its first introduction the Percutaneous fixation of scaphoid fractures has gained an increasing popularity and numerous refinement and modifications of the technique has been developed.3,15,17,18,19,20,21,24,25,28 The approach of fixation has always been a debatable issue. The dorsal approach was popularized by Slade et al by using the ring sign of the flexed scaphoid to help the placement of the guide wire within the

The decision is generally dependent on the fracture location. For more proximal fractures a dorsal pinning is recommended, with the wire being placed in an antegrade direction. Disadvantages are that the wrist must be hyperflexed and thus the k wire may be bent.

On the other hand, palmer pinning is more suitable for waist and more distal fractures. With palmer pinning it is easy to find the entry point because the k wire does not have to cross the radiocarpal joint and it is easy to maintain fracture reduction as the wrist is kept in extension. This makes the use of palmer approach more popular.

Acute fixations of non displaced or minimally displaced scaphoid fractures remain a controversial issue. Most of these fractures would unite with cast immobilization. However acute fixation of the scaphoid avoids the dilemma of when to discontinue cast immobilisation as diagnosis of union can be very difficult , . It is very difficult to assess scaphoid fracture healing by conventional radiography because the surface of the scaphoid bone is almost completely covered by articular cartilage making fracture healing an intraosseous process