Date: Wed, 30 Jul 2003 21:44:27 +0300

Subject: Old Comminuted Scaphoid Fx

dear all

male 31y with old comminuted scaphoid fracture from 4y ago.

what is best to do? - wrist arthrodesis, four corner fusion, proximal row carpectomy......

thanks

Dr. Firas Berro

Date: Sun, 3 Aug 2003 15:18:33 -0500

From: Frederic B. Wilson, M.D.

Dear Firas,

While I am no hand surgeon it strikes me that the long standing nature and the severity of the problem make a reconstruction problematic. I would believe that a proximal row carpectomy would be the best option.

I would love to hear from our Hand Surgery colleagues on this one.

Frederic B. Wilson, M.D.
Assistant Professor Trauma and Adult Reconstruction
Department of Orthopaedic Surgery
Tulane University School of Medicine
New Orleans, Louisiana

Date: Sun, 3 Aug 2003 21:54:53 -0400

From: Tom Kaplan

Would vote for four corner fusion. Concern for PRC due to young age of patient and likely proximal capitate cartilage wear. Wrist fusion overkill at this time. Make sure to correct any lunate extension deformity (cannot make out on Lateral x-ray provided) and preserve relationship of the 4 bones (i.e. do not shorten the carpus when removing the cartilage).

Good luck

Tom Kaplan
Baltimore, MD