• Can be performed antegrade (i.e. from
proximal to distal) or retrograde.
• The antegrade technique is used for
proximal pole fractures.
• The retrograde technique is used for
waist or more distal fractures.
• Can be carried out as day case surgery
under regional or general anaesthesia.
• A guide wire is passed across the
fracture under X-ray guidance, along
the central axis of the bone.
• A headless screw is then passed over
the guide wire and buried within the
• The screw has a differential pitch,
meaning that when inserted it leads to
compression at the site of the fracture,
optimising the chance of healing.
• It is unusual to need the screw to be
removed in the medium to long-term.
Percutaneous screw fixation of
the scaphoid – technical aspects
Mr Gidwani has been a Consultant
Orthopaedic Hand Surgeon at
Guy’s and St Thomas’ Hospital
since 2009 and Lead Clinician of
the Department of Orthopaedics
since October 2014. He qualified
at King’s College London in 1995,
completed his orthopaedic training
in SouthWest London and carried
out his fellowship training at
recognised hand surgery centres
in Oxford, Derby and Brisbane.
He has also been awarded the
British Postgraduate Diploma in
Mr Gidwani runs a regular
specialist hand and wrist clinic
at St Thomas’ Hospital, receiving
secondary and tertiary referrals
from across the South East. He
provides theWrist Trauma and
Reconstructive Service to the
Orthopaedic Department and also
contributes to the Regional Plastics
Hand Trauma Service based at
St Thomas’ Hospital.
He treats amateur and professional
sportsmen and women and was a
member of the team of surgeons
dealing with athletes’ hand and
wrist injuries during the 2012
London Olympics. His special
interests include osteoarthritis and
rheumatoid arthritis, Dupuytren’s
disease, nerve compression
syndromes, tendon transfer surgery
and wrist and hand trauma.www.londonhandsurgeon.co.uk www.workinghandscharity.org
MR SAM GIDWANI
Name: Mr A. F.
A 22-year-old Masters student was pushed over
during a game of ve-a-side football and landed on his
outstretched dominant left hand. His wrist gradually became more
painful over the evening, so the following day he saw his GP who
suspected he may have a scaphoid fracture. Radiographs were
carried out which con rmed the diagnosis of an un-displaced
scaphoid waist fracture, and he was referred to Mr Gidwani.
After a discussion of the pros and cons of cast treatment versus
percutaneous xation, the patient elected to be treated in a cast. He
returned to the clinic within a week, however, having changed his mind
– he was frustrated by the cast, and by the dif culties he experienced
while trying to write and take notes during lectures.
A few days later, a percutaneous xation was carried out. He was kept
in a cast for two weeks, before being transferred into a removable splint.
A CT scan carried out at 12 weeks post-operatively con rmed complete
union of the fracture and at that stage, all restrictions were lifted on use
of the wrist for sports and leisure activities.
At four months post-op, he has recovered a full range of motion
4 and 5)
, is back to skiing and playing football, and hopes to be back
on the basketball court soon.
of the scaphoid waist
typical scar left after
Figures 4 & 5:
of range of motion
For more information on Hand and Wrist Services, please contact the GP Liaison Department on:
T: 020 7234 2009
Mr Sam Gidwani