AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

3. Arthroscopic Assisted Dorsal Percutaneous Techniques
a. Slade, Gutow, Geissler 25
1) 27 acute scaphoid fractures: 17 waist, 109 proximal pole
2) Arthroscopic assisted, dorsal percutaneous fixation
3) 100% union at 12 weeks
IV. Mini-Open Techniques
A. Definition – what constitutes “mini-open” technique?
1. Is it an incision less than 2 cm, or is it a technique that does not
violate ligamentous structures and avoids excessive tissue dissection?
2. Definition not standardized and as such, many techniques may be
included in this category.
B. Dorsal Mini-Open
1. Excellent for proximal pole scaphoid fracture
a. Rettig, Raskin 24
1) 17 patients
2) Acute unstable proximal pole
3) Retrograde fixation with Herbert Screw via dorsal approach
4) Average time to union 10 weeks
5) ORIF is better means than casting to reduce complications
of delayed union, nonunion, osteonecrosis
C. Volar Mini-Open
1. Techniques that utilize small incision to expose volar lip of
scaphoid or used to ronguer portion of trapezium to gain access to scaphoid
V. Does Volar vs. Dorsal Matter?
A. Chan, McAdams 4
1. Cadaveric study to compare central positioning of screw via dorsal
or volar percutaneous placement
2. Proximal dorsal placement allowed for more central placement of
screw compared to volar, however authors conceded that it remained
unclear if a more central screw placement translated to improved
clinical outcome
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