Date: Wed, 16 Jul 2003 20:39:42 +0300
Subject: Old Scaphoid Fx
this patient has this frx from 5 y. now has pain in extreme passive or active movement + limitation in all direction with few degrees.
what best solution for him?
Date: Wed, 16 Jul 2003 21:36:40 -0700
From: Steve Groman
Do you have a lateral view? Is there a DISI collapse deformity that needs correcting? Either way, I think it needs an attempt at ORIF with bone graft and possible radial styloidectomy if arthritis is significant, with correction of the deformity of the scaphoid if needed. A Herbert bone screw (or a Herbert-Whipple cannulated one) and iliac crest graft. The fact that there is increased density to the proximal pole does not change my recommendation. IF the proximal pole is extremely small, this can approached from the dorsum, but correction of angular deformities are more difficult there. I think the proximal pole is large enough, and the volar approach is the best.
Date: Thu, 17 Jul 2003 08:13:43 EDT
I do not think one can salvage the scaphoid. Nonunion and probable proximal avn.
Wrist frusion if significant radiocarpal arthritis.
Proximal row resection may give 50% ROM but someone I respect a great deal and trained under never felt his did as well as others said.
Scaphoid resection and "four corner" fusion probably the best.
Sincerely and respectively,
M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005