15. www.handsurgery.gr
Scaphoid Nonunions
I Delayed presentation at 4-12 wk
II Fibrous union, minimal fx line
III Minimal sclerosis < 1 mm
IV Cystic formation, 1-5 mm
V Humpback deformity
VI Wrist arthrosis
Slade-Geissler Classification
16. www.handsurgery.gr
Scaphoid Nonunions
I Delayed presentation at 4-12 wk
II Fibrous union, minimal fx line
III Minimal sclerosis < 1 mm
IV Cystic formation, 1-5 mm
V Humpback deformity
VI Wrist arthrosis
Slade-Geissler Classification
Dorsal Arthroscopically
Assisted Fixation
17. www.handsurgery.gr
Scaphoid Nonunions
I Delayed presentation at 4-12 wk
II Fibrous union, minimal fx line
III Minimal sclerosis < 1 mm
IV Cystic formation, 1-5 mm
V Humpback deformity
VI Wrist arthrosis
Slade-Geissler Classification
Dorsal Arthroscopically Assisted
Fixation + Bone Graft
Complications associated with open reduction fixation include avascular necrosis, carpal instability, donor site pain, infection, screw protrusion, and reflex sympathetic dystrophy resulting from the significant soft tissue dissection that is required. The most commonly reported complication in one series was hypertrophic scarring.
Arthroscopy can aid optimal guide wire positioning witha dorsal approach. It is invaluable in assessing the qualityof fracture reduction. It is especially indicated followingpercutaneous fi xation of a comminuted fracture to evaluatethe rigidity of fi xation because seemingly good screw pur-chase may not adequately stabilize a comminuted segment.One can assess screw length and ensure that there is noradiocarpal penetration with retrograde (volar) insertion orconversely to check that the screw threads are well buriedin the proximal pole with dorsal (antegrade) insertion. It is auseful adjunct to rule out associated soft tissue injuries.