Arthroscopic assisted Scaphoid non-union grafting and fixation using Acutrak screw surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Arthroscopic assisted Scaphoid non-union grafting and fixation using Acutrak screw surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Arthroscopic assisted Scaphoid non-union grafting and fixation using Acutrak screw surgical procedure.
This procedure is designed to follow on from the Diagnostic Wrist Arthroscopy technique published in OrthoOracle.
This is a detailed step by step instruction through the procedure of an arthroscopic graft and mini-open screw fixation of a scaphoid non-union using the Acumed TM ARC Tower traction system and Mini Acutrak TM screw.
Scaphoid non-unions are best diagnosed and morphology assessed on a CT scan if subtle, although they are usually clearly seen in a scaphoid series of radiographs. An MRI can be used to try to assess the vascularity of the proximal fragment in proximal pole fractures however MRI scans (with or without Gadolinium) are far from infallible and the gold standard test for vascularity remains punctate bleeding from the bone intra-operatively.
When an non-union is established, in the absence of associated arthritis, and is symptomatic it usually requires treatment for which there are a number of options available.
Treatment options will often vary depending on the amount of collapse of the scaphoid, sclerosis or cyst formation around the non-union, location of the non-union within the scaphoid and the skill and preferences of the surgeon.
Options include – simple screw or k-wire fixation with or without graft. Grafting open or arthroscopic and can be vascularised or non-vascularised, cancellous or cortico-canecellous with the most common donor sites being distal radius and iliac crest.
Arthroscopic scaphoid grafting is an evolving technique and is best attempted once the surgeon is already confident and adept in more routine arthroscopic procedures such as joint debridements and Triangular fibro-cartilage complex (TFCC) repairs.
When embarking on this procedure for the first time it is best to attempt a non-union with minimal bony deformity which does not need correcting and located in the waist of the scaphoid. This means the fracture site can be easily accessed, there are large fragments with good vascularity proximally and distally to hold a screw and no manipulation of the fragments is required intra-operatively.
The main theoretical advantage of this technique is the preservation of vascularity by minimal soft tissue dissection which as there is no clear evidence proving the benefit of vascular over non-vascularised grafting techniques then it is a very attractive option. It also aims to reduce scarring around the joint and try to preserve mobility post-operatively.
Following an arthroscopic scaphoid grafting and mini open screw fixation patients are usually placed in plaster cast for 6-8 weeks with physio therapy of the fingers and thumb followed by cast removal and physiotherapy of the wrist once union is confirmed radiologically and clinically.
Complications in this procedure include non-union, metalwork issues, infection, iatrogenic cartilage injuries and tendon and nerve injuries.
Author: Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Queen Elizabeth Hospital, Birmingham, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.